PURPOSE: To determine whether the pattern of low detectable prostate-specific antigen (PSA) during the first 3 years of follow-up after radical prostatectomy (RP) is a predictor for subsequent biochemical recurrence (BCR).
MATERIALS AND METHODS: An institutional database was queried to identify 1136 patients who underwent open retropubic RP (ORP) or robot-assisted RP (RARP) 1/5/1993 - 12/29/2008. After applying exclusion criteria, serum PSA and pattern during the first 3 years of follow-up were used to separate 566 men into 3 groups: 1) undetectable PSA (UD; PSA ≤ 0.03 ng/ml); 2) low detectable stable PSA (LD-Stable; PSA >0.03 and < 0.2; no 2 subsequent increases and/or PSA velocity (PSAV) < 0.05 ng/year); 3) low detectable unstable PSA (LD-Unstable; PSA >0.03 and < 0.2; 2 subsequent increases (National Comprehensive Cancer Network [NCCN]) and/or PSAV ≥0.05 ng/year). The primary end point was BCR, which was defined as PSA ≥0.2 or receipt of radiation therapy (XRT) beyond 3 years of follow-up.
RESULTS: 7-year BCR-free survival was 95%, 94%, and 37% for the UD, LD-Stable, and LD-Unstable groups, respectively (Log-rank test, p< 0.0001). On multivariate analyses, the PSA pattern during the 3 years after operation (UD versus LD-Unstable, HR=15.9; UD versus LD-Stable, HR=1.6), pathological T (pT2 versus >pT2, HR=1.8), pathological Gleason score (< 7 versus 7, HR=2.3; < 7 versus 8-10, HR=3.3) and surgical margins (negative versus positive, HR=1.8) significantly predicted BCR.
CONCLUSION: The combination of PSAV and NCCN criteria for BCR separated well men with low detectable PSA after RP into those who require treatment from those who can be watched safely.
Written by:
Koulikov D, Mohler MC, Mehedint DC, Attwood K, Wilding GE, Mohler JL. Are you the author?
Department of Urology, Roswell Park Cancer Institute, Buffalo, New York; Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, New York.
Reference: J Urol. 2014 May 21. pii: S0022-5347(14)03620-9.
doi: 10.1016/j.juro.2014.05.088
PubMed Abstract
PMID: 24859441
UroToday.com Prostate Cancer Section
