The Academic Department of Urology, Pathology and Statistics of La Pitié-Salpétrière, Groupe Hospitalo-Universitaire EST, Assistance-Publique Hôpitaux de Paris, 47-83 bvd de l'Hôpital, 75013, Paris, France.
To determine the prognostic factors of biochemical recurrence in patients who failed to achieve an undetectable prostate-specific antigen (PSA) after radical prostatectomy (RP) for prostate cancer.
We reviewed data on 240 men who underwent RP as first-line treatment and who had a PSA assay available at 6 weeks after surgery. Persistent detectable PSA was defined as a PSA level ≥0.1 ng/ml at 6 weeks after surgery.
Overall, 83 men presented persistently elevated PSA after RP and 81 had a biochemical recurrence. Median follow-up was 44 months. In univariate analysis, these factors were associated with biochemical recurrence: preoperative PSA level (P < 0.0001), biopsy and pathologic Gleason score (P < 0.001), capsular involvement (P = 0.0001), positive surgical margins (P < 0.0001), pathological stage ≥T3 (P = 0.0001), and detectable post-operative PSA ≥0.1 ng/ml (P = 0.0001). In a multivariate analysis, only the detectable post-operative PSA level ≥0.1 ng/mL (P = 0.001), positive surgical margins (P = 0.002), and pathological stage ≥T3 (P < 0.001) were significant. The individual, five-year, PSA-free survival rate for men with post-operative PSA < 0.1 ng/ml and ≥0.1 ng/ml were 59 and 42%, respectively (P < 0.001).
A majority of patients who failed to achieve an undetectable PSA after surgery had a subsequent biochemical recurrence in the outcome. A systematic PSA assay 6 weeks after RP could be useful to early identify patients who are likely to recur.
Audenet F, Seringe E, Drouin SJ, Comperat E, Cussenot O, Bitker MO, Rouprêt M. Are you the author?
Reference: World J Urol. 2011 Jun 3. Epub ahead of print.