Opportunities for Quality Improvement in Postoperative Prostate-Specific Antigen Testing After Radical Prostatectomy.

[INTRODUCTION] After radical prostatectomy (RP), PSA testing is performed to identify persistent or recurrent prostate cancer. We explored the timing and results of initial PSA testing after RP.

[METHODS] Patients undergoing RP within the Michigan Urological Surgery Improvement Collaborative from March 2012 to December 2023 were included. Timing and detectable value of initial and confirmatory PSA testing were measured.

[RESULTS] Of 21,991 patients, 81.9% had an initial PSA < 90 days of surgery, 9.9% had initial PSA within 91 to 120 days, 6.2% had initial PSA > 120 days, and 2.0% had no available postoperative PSA. Two thousand two hundred ninety-two of 18,021 patients (17.6%) with PSA < 90 days had an initial value > 0.1 ng/mL, of whom 20% had no confirmatory PSA within 6 months. Four hundred fifty-two patients (2.1%) had PSA < 3 weeks of RP, of which 77% were > 0.1 ng/mL, and repeat PSA testing remained > 0.1 ng/mL in only 21%. Two thousand eight hundred twenty-nine patients (12.9%) tested PSA 3 to 5 weeks after RP, with 15% > 0.1 ng/mL and 52% remained > 0.1 ng/mL. By contrast, only 10% of PSA values obtained > 5 weeks were > 0.1 ng/mL, and 80% remained > 0.1 ng/mL on repeat testing.

[CONCLUSIONS] Initial PSA testing < 5 weeks after RP provides unclear results, with false-positive detectable results that often become undetectable when repeated. Alternatively, repeat PSA testing confirmed detectable PSA in 80% of patients whose initial PSA was 35 to 90 days after RP. Opportunities for education and quality improvement include (1) initial PSA testing is best performed > 5 weeks and < 90 days after surgery and (2) timely confirmatory PSA testing is required when the initial PSA is detectable.