Current PSA monitoring guidelines may lead to overtreatment after prostate surgery

After surgical removal of the prostate to treat prostate cancer, clinicians monitor Prostate Specific Antigen (PSA) levels. Persistently elevated PSA levels indicate residual cancer and are linked to worse outcomes. But in a paper published in JAMA Oncology, Mass General Brigham researchers found that the current standard monitoring time of one-and-a-half to two months following surgery is too short to accurately identify recurrence and inform treatment decisions. Rather, PSA levels should be measured for at least three months to avoid overtreatment.

"Checking the PSA level too soon can lead clinicians to mislabel a patient as having recurred and prompt referral to radiation and medical oncologists to initiate salvage radiation and hormonal therapy," said senior author Anthony D'Amico, MD, PhD, chief of Genitourinary Radiation Oncology at Brigham and Women's Hospital, a founding member of the Mass General Brigham healthcare system. "It can take longer than three months for many patients who have PSA levels > 20 prior to surgery to completely clear the PSA from their bloodstream."

The clinical significance of these findings is that they highlight the need to monitor PSA after surgery for longer than the commonly practiced one-and-a-half to two months before concluding that PSA levels are persistent and initiating additional therapy."

Anthony D'Amico, MD, PhD, Chief of Genitourinary Radiation Oncology, Brigham and Women's Hospital