前列腺癌根治术后若血清前列腺特异性抗原（PSA）结果呈阳性，则通常提供抢救治疗；若呈阴性，则继续监测。我们旨在更好地了解那些在根治手术后初始PSA阴性，但在手术后6个月以上转为阳性的男性的自然发展。对2000年至2022年在旧金山加州大学接受根治性前列腺癌切除手术的男性进行了回顾性分析。主要结果为生化复发，定义为手术后6个月起连续2次PSA≥0.03 ng/mL。二级结果为抢救治疗、抢救治疗后、无转移生存（MFS）、前列腺癌特定死亡率（PCSM）和全因死亡率（ACM）。这一队列与先前描述的具有立即检测到手术后PSA阳性的队列进行了比较。从我们的队列中，我们识别出2868名术后PSA呈阴性的男性中的642名，他们在术后25个月的中位数（IQR为15，43）出现了延迟检测到的PSA，手术后中位随访时间为72个月。治疗失败时的PSA对于65.7%的男性来说小于0.10 ng/mL。其中，46%的延迟检测到PSA的患者在手术后10年内以中位数0.08 ng/mL的PSA接受了抢救治疗。CAPRA-S高评分（HR1.09，CI1.02-1.17，p=0.02）和PSA倍增时间（PSA-DT）<6个月（HR7.58，CI5.42-10.6，p<0.01）与接受抢救治疗有关。在抢救治疗后，10年内62%的男性出现了复发PSA失败。总体而言，10年内MFS为92%，PCSM为3%，ACM为6%。对于那些接受复发PSA治疗的人，10年后的MFS为54%，PCSM为23%，ACM为23%。即使没有抢救治疗，术后6个月后PSA阳性的男性也可能具有出色的长期结果。©2023年作者。

Men with a detectable PSA after radical prostatectomy (RP) are often offered salvage therapy while those with an undetectable PSA are monitored. We aim to better characterize the natural history of men with an initially undetectable PSA who subsequently developed a detectable PSA > 6 months after RP.Retrospective analysis of men who underwent RP for clinically localized prostate cancer at the University of California, San Francisco from 2000 to 2022. The primary outcome was biochemical recurrence, defined as 2 consecutive PSA > = 0.03 ng/mL starting 6 months after surgery. Secondary outcomes were salvage treatment, post-salvage treatment, metastasis free survival (MFS), prostate cancer specific mortality (PCSM), and all-cause mortality (ACM). This cohort was compared to a previously described cohort who had an immediately detectable post-operative PSA.From our cohort of 3348 patients, we identified 2868 men who had an undetectable post-op PSA. Subsequently, 642 men had a delayed detectable PSA at a median of 25 months (IQR 15, 43) with median follow-up of 72 months after RP. PSA at time of failure was <0.10 ng/mL for 65.7% of men. Of those with a delayed detectable PSA, 46% underwent salvage treatment within 10 years after RP at a median PSA of 0.08 ng/mL (IQR 0.05, 0.14). High CAPRA-S score (HR 1.09, CI 1.02-1.17, p = 0.02) and PSA doubling time (PSA-DT) of <6 months (HR 7.58, CI 5.42-10.6, p < 0.01) were associated with receiving salvage treatment. After salvage treatment, 62% of men had recurrent PSA failure within 10 years. Overall, MFS was 92%, PCSM 3%, and ACM 6% at 10 years. For those who received tertiary treatment for recurrent PSA failure, MFS was 54%, PCSM 23% and ACM 23% at 10 years' time.Men who develop a detectable PSA > 6 months post-operatively may have excellent long-term outcomes, even in the absence of salvage therapy.© 2023. The Author(s).