BACKGROUND: The purpose of this article was to determine the impact of time to undetectable prostate-specific antigen (PSA) for predicting biochemical recurrence (BCR) in patients with a positive surgical margin (PSM) following radical prostatectomy (RP). A PSM is an independent predictor of BCR; however, not all patients develop BCR later on.
METHODS: A retrospective analysis was conducted on 1,117 consecutive prostate cancer patients who underwent RP without neoadjuvant or adjuvant therapy from July 2005 to December 2009. Of these, 516 (46.2 %) patients without PSMs, and 214 (19.2 %) patients with PSMs who later achieved undetectable PSA, defined as < 0.01 ng/ml, were identified. Patients with PSMs were stratified according to time to undetectable PSA dichotomized at 6 weeks and compared with patients without PSMs. Patients with PSMs who did not achieve undetectable PSA were excluded. BCR was defined as two consecutive increases of post-undetectable PSA ≥0.2 ng/ml.
RESULTS: During the median follow-up of 58.2 months, patients with PSMs who achieved undetectable PSA in < 6 weeks had comparable 5-year BCR-free survival rates to those without PSMs; however, patients with PSMs who achieved undetectable PSA in ≥6 weeks showed significantly lower rates compared with both patients without PSMs (59.2 vs 74.3 %; p < 0.001) and patients with PSMs who achieved undetectable PSA in < 6 weeks (59.2 vs 78.8 %; p = 0.004). Among patients with PSMs, multivariate analysis revealed time to undetectable PSA at ≥6 weeks and seminal vesicle invasion to be independent predictors of BCR. No perioperative factors were associated with undetectable PSA at ≥6 weeks.
CONCLUSIONS: Patients with PSMs who achieve undetectable PSA in < 6 weeks show comparable risks of BCR to patients with negative surgical margins.
Koo KC, Tuliao P, Komninos C, Choi YD, Chung BH, Hong SJ, Jee SH, Rha KH. Are you the author?
Departments of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
Reference: Ann Surg Oncol. 2014 Sep 5. Epub ahead of print.