Undetectable ultrasensitive PSA after radical prostatectomy for prostate cancer predicts relapse-free survival (original) (raw)
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BJU International, 2006
To evaluate the influence of preoperative serum prostate-specific antigen (PSA) level and other clinicopathological variables on the probability of biochemical failure and clinical recurrence after radical prostatectomy (RP) for localized prostate cancer. The study was a retrospective survival analysis in 211 patients undergoing retropubic RP for clinically localized prostate cancer in the period 1988-2000. Survival was estimated using the Kaplan-Meier method; survival endpoints were biochemical failure, defined as a PSA level of > or = 0.5 ng/mL or clinical recurrence consisting of palpable tumours in the prostatic fossa or distant metastases. In 58 patients with biochemical failure after surgery, we assessed the impact of the doubling time of serum PSA level (PSADT) on the risk of developing skeletal metastases or local recurrence. The median (range) observation period was 66 (9-160) months. Biochemical failure occurred in 92 patients (44%) of whom 39 (42%) had local recurrence or skeletal metastases. There was a highly significant association (P < 0.001) between clinical T stage, histological grade, capsular penetration, surgical margin status, seminal vesicle invasion, preoperative serum PSA level and the probability of biochemical failure-free survival. By contrast there was no statistically significant association between preoperative serum PSA level, clinical T stage, surgical margin status, and clinical recurrence. There was a significant relationship between age (P = 0.021), histological grade (P = 0.025), capsular penetration (P = 0.018), seminal vesicle invasion (P = 0014), and clinical recurrence. Cox regression analysis showed that only histological grade and seminal vesicle invasion were independent predictors of clinical recurrence. In a subgroup of 58 patients with a rising serum PSA level after RP, a PSADT of < or = 12.8 months conferred a significantly higher risk (P = 0.015) of developing skeletal metastases than a PSADT of >12.8 months. In the present patients undergoing RP the preoperative serum PSA level was not associated with the clinical outcome, whereas it was significantly related to biochemical failure rate. The probability of skeletal metastases was significantly associated with the PSADT after biochemical failure.
2000
We used an ultrasensitive prostate-specific antigen (PSA) assay with a detection limit of 0.02 g/L for long-term monitoring of PSA changes in 5 patients who were cured by radical prostatectomy and in 10 patients who had failed prostatectomies; 5 patients who underwent cystoprostatectomy were also evaluated with one sample after surgery. Relapse-free periods, determined on the basis of criteria designed specifically for the ultrasensitive assay or proposed for other currently available PSA assays, were calculated for the patients with failed prostatectomies. Tumor-doubling times were also calculated, postsurgery, according to a model that assumes exponential tumor growth over time. We found that prostate cancer relapse, on average, could be diagnosed 420 or 883 days earlier with the ultrasensitive assay than with assays having detection limits of 0.1 or 0.3 g/L, respectively. Tumor-doubling times, calculated after radical prostatectomy, ranged from 67 to 568 days among the 10 patients. We also present evidence that even moresensitive PSA assays might be able to further reduce the relapse-free periods in -50% of the prostate cancer patients who ultimately relapse.
World Journal of Urology, 2012
To determine the prognostic factors of biochemical recurrence in patients who failed to achieve an undetectable prostate-specific antigen (PSA) after radical prostatectomy (RP) for prostate cancer. We reviewed data on 240 men who underwent RP as first-line treatment and who had a PSA assay available at 6 weeks after surgery. Persistent detectable PSA was defined as a PSA level ≥ 0.1 ng/ml at 6 weeks after surgery. Overall, 83 men presented persistently elevated PSA after RP and 81 had a biochemical recurrence. Median follow-up was 44 months. In univariate analysis, these factors were associated with biochemical recurrence: preoperative PSA level (P < 0.0001), biopsy and pathologic Gleason score (P < 0.001), capsular involvement (P = 0.0001), positive surgical margins (P < 0.0001), pathological stage ≥ T3 (P = 0.0001), and detectable post-operative PSA ≥ 0.1 ng/ml (P = 0.0001). In a multivariate analysis, only the detectable post-operative PSA level ≥ 0.1 ng/mL (P = 0.001), positive surgical margins (P = 0.002), and pathological stage ≥ T3 (P < 0.001) were significant. The individual, five-year, PSA-free survival rate for men with post-operative PSA <0.1 ng/ml and ≥ 0.1 ng/ml were 59 and 42%, respectively (P < 0.001). A majority of patients who failed to achieve an undetectable PSA after surgery had a subsequent biochemical recurrence in the outcome. A systematic PSA assay 6 weeks after RP could be useful to early identify patients who are likely to recur.
Early detection of prostate cancer local recurrence by urinary prostate-specific antigen
Canadian Urological Association journal = Journal de l'Association des urologues du Canada, 2009
We assessed the role of urinary prostate-specific antigen (uPSA) in the follow-up of prostate cancer after retropubic radical prostatectomy (RRP) for the early detection of local recurrences. We recruited 50 patients previously treated for prostate cancer with RRP and who had not experienced a prostate-specific antigen (PSA) recurrence within their first postoperative year into a cross-sectional laboratory assessment and prospective 6-year longitudinal follow-up study. We defined biochemical failure as a serum PSA (sPSA) of 0.3 μg/L or greater. Patients provided blood samples and a 50-mL sample of first-voided urine. We performed Wilcoxon rank-sum and Fisher exact tests for statistical analysis. The median sPSA was 0.13 μg/L. The median uPSA was 0.8 μg/L, and was not significantly different when comparing Gleason scores or pathological stages. Of the 50 patients, 27 initially had a nondetectable sPSA but a detectable uPSA, and 11 patients experienced sPSA failure after 6 years. Six ...
Oncology Letters, 2012
2]pro-prostate-specific antigen (2pPSA), a proform of PSA, is a new marker in patients at risk of prostate cancer. We explored the potential role of 2pPSA in the identification of patients with metastatic progression following radical prostatectomy for prostate cancer. Seventy-six patients with biochemical (PSA) recurrence following radical prostatectomy were studied retrospectively. Diagnostic imaging performed at the time of biochemical recurrence confirmed metastatic disease in 31 of the 76 patients. Serum samples were collected and stored at the time of imaging-confirmed metastatic progression or at the most recent procedure for patients with negative imaging. Median values of PSA, free PSA (fPSA), %fPSA, 2pPSA and prostate health index (PHI) were compared between metastatic and non-metastatic patients by the Mann-Whitney U test. The results of each test were then correlated with metastatic status by univariate and multivariate logistic regression analysis. PSA, fPSA, %fPSA, 2pPSA serum concentrations and PHI values were statistically significantly higher in patients with metastatic disease. Results of the multivariate analysis revealed that 2pPSA remained a statistically significant predictor of imaging-proven metastatic prostate cancer among patients with biochemical recurrence. At a cut-off value of 12.25 pg/ml, 2pPSA outperformed the other markers in terms of sensitivity and specificity (97 and 80%, respectively) with respect to imaging-confirmed metastatic progression. This is the first study suggesting that 2pPSA predicts diagnostic imaging-proven metastatic disease in previously resected prostate cancer patients with biochemical recurrence. Our results merit validation in a prospective study.