402 ULTRASENSITIVE PROSTATE-SPECIFIC ANTIGEN NADIR AND TIME TO NADIR CAN BE USED TO IDENTIFY MEN WHO ARE AT HIGH RISK OF PROSTATE CANCER RECURRENCE AFTER RADICAL PROSTATECTOMY

Abstract

You have accessJournal of UrologyProstate Cancer: Staging III1 Apr 2010402 ULTRASENSITIVE PROSTATE-SPECIFIC ANTIGEN NADIR AND TIME TO NADIR CAN BE USED TO IDENTIFY MEN WHO ARE AT HIGH RISK OF PROSTATE CANCER RECURRENCE AFTER RADICAL PROSTATECTOMY Stepan Vesely, Ladislav Jarolim, Marko Babjuk, Pavel Dusek, Veronika Kaliska, and Marek Schmidt Stepan VeselyStepan Vesely More articles by this author , Ladislav JarolimLadislav Jarolim More articles by this author , Marko BabjukMarko Babjuk More articles by this author , Pavel DusekPavel Dusek More articles by this author , Veronika KaliskaVeronika Kaliska More articles by this author , and Marek SchmidtMarek Schmidt More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.471AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prostate specific antigen (PSA) assessed by ultrasensitive assay enables to follow the changes of serum PSA after radical prostatectomy at very low concentrations. We aimed to determine weather the PSA nadir and time to PSA nadir could predict biochemical recurrence of prostate cancer after radical prostatectomy. METHODS Multiple ultrasensitive PSA measurements were performed in 243 men after radical prostatectomy for localized prostate cancer. Ultrasensitive PSA tests (Immulite 2000 3rd Generation PSA, Siemens Medical) with lower detection limit of 0.003 ng/ml were taken first at two weeks after the operation, then at 1, 2 and 3 months, and subsequently in 3 months intervals. Patients with PSA nadir above 0.1 ng/ml or history of prior or adjuvant hormonal therapy were excluded from the study. Recurrence of prostate cancer was defined as PSA persistently >0.2 ng/ml or the need for secondary treatment. The ability of pathologic and clinical parameters to predict cancer recurrence was assessed using a Cox proportional hazard regression model. RESULTS Of 243 patients 87 (35%) experienced biochemical recurrence or secondary treatment during a median follow-up of 25.1 months (range 6-90). Patients with recurrence reached significantly higher values of PSA nadir (p<0.0001). Relapse rates in men with PSA nadir ≤0.01 ng/ml (n=115) and PSA nadir >0.01 ng/ml (n=128) were 14 % and 60%, respectively (p<0.001). Men who attained PSA nadir within first 3 months after the operation (n=173) demonstrated the relapse rate of 42.7% in the comparison with the patients (n=70) who reached the PSA nadir later 16.6% (p<0.001). Cox proportional hazards modeling to predict recurrence confirmed that PSA nadir > 0.01 ng/ml (HR 4.11, 95%CI 2.02-9.08, p<0.001) and time to nadir up to 3 months (HR 6.88, 95%CI 2.78-21.25, p<0.005) were significant independent predictors of recurrence, as were Gleason score and preoperative value of PSA. CONCLUSIONS The level of PSA nadir and the time to PSA nadir determined by ultrasensitive assay predict the outcome of radical prostatectomy and should be considered with other known prognostic factors to identify patients who are at high risk of disease recurrence. Prague, Czech Republic© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e159 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Stepan Vesely More articles by this author Ladislav Jarolim More articles by this author Marko Babjuk More articles by this author Pavel Dusek More articles by this author Veronika Kaliska More articles by this author Marek Schmidt More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...