前列腺特异性抗原 (PSA) 检测用于随访接受根治性前列腺切除术 (RP) 治疗的前列腺癌 (PCa) 患者。用于识别具有较高进展风险的生化复发 (BCR) 前列腺癌患者的 PSA 阈值研究产生了不确定的结果。本研究旨在调查接受 RP 治疗的 PCa 患者和术后长期（120 个月）检测不到 PSA 随访的晚期 BCR 风险，并确定该患者队列中晚期 BCR 的预后因素。接受治愈性 RP 治疗的 PCa 患者（1992 年） -2012 年），并且在 RP 后的前 120 个月内没有 BCR，在五个欧洲高等教育中心进行了回顾性鉴定； BCR 定义为连续两次 PSA 值≥0.2 ng/ml。 Kaplan-Meier 和 Cox 回归模型测试了 BCR 与患者或肿瘤特征之间的关联。研究队列由 4639 名患者组成，其中 243 名患者 (5.2%) 在 147 个月的中期随访中出现了 BCR。在 BCR 患者中，23 人 (9.5%) 随后出现转移进展。在 Kaplan-Meier 模型中，无 BCR 生存期根据晚期肿瘤状态而有所不同。在多变量 Cox 回归模型中，pT 分期（pT3a：风险比 [HR]：1.46；pT3b：HR：2.42）、病理 Gleason 评分（pGS 3   4：HR：1.71；pGS ≥4   3：HR：2.47）、手术切缘（R1/Rx：HR：1.72）和 pNx 阶段（pNx：HR：0.72）代表 BCR 的独立预测因子（所有 p < 0.05）。相反，年龄、诊断时的 PSA 和手术年份未能达到 BCR 的独立预测状态。在 RP 后至少 10 年顺利随访的 PCa 患者中，仍有十分之一的患者随后出现晚期 BCR。然而，pT2 期和 pGS ≤ 3 4 的患者中，晚期 BCR 和随后进展为转移 (0.3%) 的比率惊人地低，这意味着在这组患者中，在 10 年平静期之后放弃随访是合理的。这项研究在五个欧洲中心确定了接受根治性前列腺切除术治疗并至少进行了 10 年平安前列腺特异性抗原检测的前列腺癌患者。根据这些患者的情况，计算出随后的晚期生化复发率，并在 10 年平安无事的前列腺特异性抗原检测后确定了生化复发的危险因素。版权所有 © 2024 欧洲泌尿外科协会。由 Elsevier B.V. 出版。保留所有权利。

Prostate-specific antigen (PSA) testing is used to follow up prostate cancer (PCa) patients treated with radical prostatectomy (RP). Research on PSA thresholds for identifying PCa patients with biochemical recurrence (BCR) who are at a higher risk of progression yielded inconclusive results. This study aims to investigate the risk of late BCR in PCa patients treated with RP and long postoperative (120 mo) undetectable PSA follow-up, and to identify prognostic factors for late BCR within this patient cohort.PCa patients treated with curative RP (1992-2012) and free of BCR during the first 120 mo following RP were retrospectively identified within five European tertiary centers; BCR was defined as two consecutive PSA values of ≥0.2 ng/ml. Kaplan-Meier and Cox regression models tested for an association between BCR and patient or tumor characteristics.The study cohort consisted of 4639 patients, of whom 243 (5.2%) developed BCR at a medium follow-up of 147 mo. Of those with BCR, 23 (9.5%) subsequently developed metastatic progression. In Kaplan-Meier models, BCR-free survival differed according to advanced tumor status. In multivariable Cox regression models, pT stage (pT3a: hazard ratio [HR]: 1.46; pT3b: HR: 2.42), pathological Gleason score (pGS 3 + 4: HR: 1.71; pGS ≥4 + 3: HR: 2.47), surgical margin (R1/Rx: HR: 1.72), and pNx stage (pNx: HR: 0.72) represented independent predictors for BCR (all p < 0.05). Conversely, age, PSA at diagnosis, and year of surgery failed to achieve independent predictor status for BCR.Among PCa patients with an uneventful follow-up of at least 10 yr after RP, still one in 20 patients subsequently develop late BCR. Nevertheless, late BCR and subsequent progression to metastasis (0.3%) rates in patients with pT2 stage and pGS ≤3 + 4 were strikingly low, implicating that abandoning follow-up beyond an uneventful period of 10 yr is justifiable within this cohort of patients.In this study, prostate cancer patients treated with a radical prostatectomy and at least 10 yr of uneventful prostate-specific antigen testing were identified within five European centers. Relying on these patients, the rate of subsequent late biochemical recurrence was calculated and risk factors were identified for biochemical recurrence following 10 yr of uneventful prostate-specific antigen testing.Copyright © 2024 European Association of Urology. Published by Elsevier B.V. All rights reserved.