Adverse pathology and undetectable ultrasensitive prostate-specific antigen after radical prostatectomy: Is adjuvant radiation warranted? - Abstract

OBJECTIVES: To determine if men with adverse pathology but undetectable ultrasensitive (< 0.01 ng/mL) PSA are at high-risk for biochemical recurrence (BCR), or if there is a subset of patients at low-risk for whom the benefit of adjuvant radiation therapy might be limited.

PATIENTS AND METHODS: We evaluated 411 patients treated with RP from 2001 to 2013 without adjuvant radiation who had an undetectable (< 0.01 ng/mL) PSA level after RP but with adverse pathology [positive surgical margins (PSMs), extraprostatic extension (EPE), and/or seminal vesicle invasion (SVI)]. Multivariable Cox regression analyses tested the relationship between pathological characteristics and BCR to identify groups of men at highest risk of early BCR.

RESULTS: On multivariable analysis, only pathological Gleason 7 (4 + 3), Gleason ≥8, and SVI independently predicted BCR (P = 0.019, P < 0.001, and P = 0.001, respectively), although on two-way analysis men with Gleason 7 (4 + 3) did not have significantly higher rates of BCR compared with patients with Gleason ≤ 6 (log-rank, P = 0.074). Men with either Gleason ≥8 (with PSMs or EPE) or SVI (15% of the cohort) defined a high-risk group vs men without these characteristics (3-year BCR risk of 50.4% vs 11.9%, log-rank, P < 0.001).

CONCLUSIONS: Among men with adverse pathology but an undetectable (< 0.01 ng/mL) PSA level after RP, the benefits of adjuvant radiation are probably limited except for men with Gleason 8-10 (with PSMs or EPE) or SVI who are at high-risk of early BCR.

Written by:
Simon RM, Howard LE, Freedland SJ, Aronson WJ, Terris MK, Kane CJ, Amling CL, Cooperberg MR, Vidal AC.   Are you the author?
Duke Prostate Center, Division of Urology, Department of Surgery and Pathology, Duke University School of Medicine, Durham, NC, USA; Urology Section, Veterans Affairs Medical Center, Durham, NC, USA; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA; Department of Surgery, Division of Urology, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Urology Section, Department of Surgery, Veterans Affairs Medical Center of Greater Los Angeles, Los Angeles, CA, USA; Department of Urology, University of California at Los Angeles Medical Center, Los Angeles, CA, USA; Urology Section, Division of Surgery, Veterans Affairs Medical Center, Augusta, GA, USA; Division of Urologic Surgery, Department of Surgery, Medical College of Georgia, Augusta, GA, USA; Division of Urology, Department of Surgery, University of California at San Diego Medical Center, San Diego, CA, USA; Department of Urology, Oregon Health and Science University, Portland, OR, USA; Department of Urology, University of California at San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA, USA; Urology Section, Department of Surgery, Veterans Affairs Medical Center, San Francisco, CA, USA.

 

Reference: BJU Int. 2015 May 24. Epub ahead of print.
doi: 10.1111/bju.13182


PubMed Abstract
PMID: 26010251

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