Extended PSA Monitoring Post-Prostatectomy May Curb Overtreatment Risks

In a groundbreaking study published in JAMA Oncology on March 13, 2025, researchers have unveiled that extending the monitoring period of prostate-specific antigen (PSA) levels to three months after radical prostatectomy (RP) for prostate cancer could significantly reduce the chances of overtreatment. This finding sheds light on optimizing patient care in the wake of cancer treatment.

Dr. Derya Tilki from University Hospital Hamburg Eppendorf in Germany led a rigorous investigation involving a substantial patient cohort. The study reviewed data from individuals diagnosed with T1N0M0 to T3N0M0 prostate cancer who underwent RP between 1992 and 2020 at two prominent academic medical centers. The initial discovery cohort encompassed 30,461 patients, complemented by a validation cohort of 12,837 patients.

Notably, the researchers discovered a concerning correlation between higher pre-RP PSA levels and the risks of both all-cause mortality (ACM) and prostate cancer-specific mortality (PCSM). Specifically, patients with pre-RP PSA levels exceeding 20 ng/mL exhibited a significantly reduced risk of mortality when compared to those with levels at or below this threshold. The adjusted hazard ratios calculated were 0.69 for ACM and 0.41 for PCSM, suggesting that stringent monitoring could guide more tailored treatment approaches.

The study also found that patients with a pre-RP PSA >20 ng/mL were more frequently subjected to post-RP interventions, such as radiation therapy combined with androgen deprivation therapy (ADT), within a shorter median timeframe—2.68 months compared to 3.30 months for those with lower PSA levels. This timely intervention emphasized the importance of patient stratification based on initial PSA readings.

Furthermore, as the persistent PSA levels rose, so did the associated risks of ACM and PCSM, suggesting a clear need for vigilant monitoring. The adjusted hazard ratios for these outcomes were 1.14 and 1.27, respectively.

The overarching conclusion of the study, as articulated by Dr. Tilki and colleagues, is the critical importance of extending the PSA monitoring timeline beyond the standard 1.5 to 2-month interval before declaring a persistent PSA elevation and subsequently initiating potentially aggressive treatments. This approach could pave the way for improved patient outcomes and the prevention of unnecessary medical interventions.

In light of these revelations, healthcare providers are encouraged to reconsider the existing protocols surrounding PSA monitoring in post-operative prostate cancer patients, promoting a more patient-centered approach that might significantly enhance survival rates and quality of life.

This research not only opens a dialogue about monitoring practices but also emphasizes the need for ongoing clinical exploration into optimal post-surgical care in urology.