The older the better: The characteristic of localized prostate cancer in Chinese men

Prognostic significance of a novel indicator (PSApostd3/PSApre) for PSA recurrence in patients after radical prostatectomy

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.