Persistent prostatic specific antigen (PSA) represents a poor prognostic factor for recurrence after radical prostatectomy (RP). However, the impact of persistent PSA on oncologic outcomes in patients undergoing salvage RP is unknown. To investigate the impact of persistent PSA after salvage RP on long-term oncologic outcomes.
Patients who underwent salvage RP for recurrent prostate cancer between 2000 and 2021 were identified from twelve high-volume centers. Only patients with available PSA after salvage RP were included. Kaplan-Meier analyses and multivariable Cox regression models were used to test the effect of persistent PSA on biochemical recurrence (BCR), metastasis and any death after salvage RP. Persistent PSA was defined as a PSA-value ≥ 0.1 ng/ml, at first PSA-measurement after salvage RP.
Overall, 580 patients were identified. Of those, 42% (n = 242) harbored persistent PSA. Median follow-up after salvage RP was 38 months, median time to salvage RP was 64 months and median time to first PSA after salvage RP was 2.2 months. At 84 months after salvage RP, BCR-free, metastasis-free, and overall survival was 6.6 vs. 59%, 71 vs. 88% and 77 vs. 94% for patients with persistent vs. undetectable PSA after salvage RP (all p < 0.01). In multivariable Cox models persistent PSA was an independent predictor for BCR (HR: 5.47, p < 0.001) and death (HR: 3.07, p < 0.01).
Persistent PSA is common after salvage RP and represents an independent predictor for worse oncologic outcomes. Patients undergoing salvage RP should be closely monitored after surgery to identify those with persistent PSA.
Prostate cancer and prostatic diseases. 2023 Oct 06 [Epub ahead of print]
Felix Preisser, Reha-Baris Incesu, Pawel Rajwa, Marcin Chlosta, Florian Nohe, Mohamed Ahmed, Andre Luis Abreu, Giovanni Cacciamani, Luis Ribeiro, Alexander Kretschmer, Thilo Westhofen, Joseph A Smith, Thomas Steuber, Giorgio Calleris, Yannic Raskin, Paolo Gontero, Steven Joniau, Rafael Sanchez-Salas, Shahrokh F Shariat, Inderbir Gill, R Jeffrey Karnes, Paul Cathcart, Henk Van Der Poel, Giancarlo Marra, Derya Tilki
Martini-Klinik Prostate Cancer Center, University Hospital Hamburg Eppendorf, Hamburg, Germany., Department of Urology, Medical University of Vienna, Vienna, Austria., Department of Urology, Mayo Clinic, Rochester, MN, USA., Keck Medical Center of USC, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA., Urology Centre, Guy's Hospital, London, UK., Department of Urology, Ludwig-Maximilians University of Munich, Munich, Germany., Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA., Department of Surgical Sciences, San Giovanni Battista Hospital and University of Turin, Turin, Italy., Department of Urology, University Hospitals Leuven, Leuven, Belgium., Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France., Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands., Martini-Klinik Prostate Cancer Center, University Hospital Hamburg Eppendorf, Hamburg, Germany. .