Comparison of oncologic outcomes after radical prostatectomy in men diagnosed with prostate cancer with PSA levels below and above 4 ng/mL - Abstract

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.

Written by:
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.
doi: 10.1007/s00345-013-1089-0

PubMed Abstract
PMID: 23619479 Prostate Cancer Section