Purpose: Radical prostatectomy (RP) is a common treatment for prostate cancer, but a fraction of patients may experience PSA recurrence after surgery, manifesting as an elevation in prostate specific antigen (PSA). Vast literature has reported different prognostic factors for PSA recurrence without reaching a consensus. This retrospective study investigated the efficacy of a new indicator in predicting PSA recurrence in patients after RP.
Patients and methods: From October 2000 to December 2015, 102 PCa patients who underwent laparoscopic prostatectomy in the Urology Department of Peking Union Medical College Hospital were analyzed. We calculated PSA_postd3/PSA_pre defined as the ratio of the PSA on day 3 postop as the numerator and the pre-operative PSA as the denominator, in these patients to represent PSA decrement after surgery, and investigated its relationship with PSA recurrence during follow-up.
Results: The receiver operating characteristic (ROC) curve of PSA_postd3/PSA_pre derived a cut-off at 0.453 (sensitivity=0.704, specificity=0.853, P <0.0001), suggesting an increased risk of PSA recurrence in patients whose PSA on day 3 postop did not decrease to approximately half of their preoperative levels. Among several factors, PSA_postd3/PSA_pre (P <0.0001), pathological T stage (P =0.042) and Gleason Grade (P =0.021) were determined to be significantly associated with PSA recurrence by Fisher’s exact test, while only PSA_postd3/PSA_pre (P <0.001) was significantly related to PSA recurrence-free survival (PRFS) by multivariate logistic regression analysis.
Conclusion: These results imply that PSA_postd3/PSA_pre could provide substantial information for PSA recurrence prediction in patients after RP.
Keywords: prognosis, prostate cancer, prostate-specific antigen