PURPOSE: To assess whether the PSA level (threshold 4 ng/mL) is a prognostic factor in biochemical recurrence-free survival in men with prostate cancer (PCa) with an initial PSA level < 10 ng/mL who underwent robotic-assisted laparoscopic radical prostatectomy (RARLP).
METHODS: We prospectively recruited data for consecutive patients treated by RARLP for PCa with an initial PSA level below 10 ng/mL between 2003 and 2011 at our institution. We divided the population into two groups: patients with a PSA level below 4 ng/mL (G1; n = 53) and patients with a PSA level between 4 and 10 ng/mL (G2; n = 371). Biochemical recurrence was defined as a single increase in PSA greater than 0.2 ng/mL after surgery. Multivariate analysis was used to assess prognostic factors of recurrence-free survival.
RESULTS: Overall, 424 patients were included, and the median age was 62 (58-67) years. The median PSA was 5.8 ng/mL (4.8-7.7 ng/mL). Overall, 6 patients from G1 and 34 patients from G2 experienced a biochemical recurrence. Overall, the 5-year recurrence-free survival rate was 86.6 %. The PSA level at diagnosis (under or over 4 ng/mL) was not significantly linked to recurrence-free survival (HR = 0.59, p = 0.25). However, positive margins and a Gleason score >7 on the specimen were significantly linked to recurrence-free survival with respective hazard ratios of 4.30 (p < 0.0001) and 6.18 (p < 0.0001), respectively.
CONCLUSION: A PSA level < 4 ng/mL alone appears to be obsolete as a cut-off to define a population of men likely to have indolent disease.
Dariane C, Le Cossec C, Drouin SJ, Wolff B, Granger B, Mozer P, Bitker MO, Shariat SF, Cussenot O, Rouprêt M. Are you the author?
Academic Department of Urology, Pitié-Salpétrière hospital (Assistance Publique-Hôpitaux de Paris), 83, Boulevard de l'hôpital, 75013, Paris, France.
Reference: World J Urol. 2013 Apr 26. Epub ahead of print.