472 PREDICTORS AND OUTCOMES OF BIOCHEMICAL PERSISTENCE VS. RECURRENCE AFTER RADICAL PROSTATECTOMY FOR PROSTATE CANCER DIAGNOSED IN THE ERA OF PSA SCREENING

Abstract

INTRODUCTION AND OBJECTIVES: Biochemical persistence (BCP) and biochemical recurrence (BCR) after radical prostatectomy (RP) may portend poor outcomes. There is a paucity of data on patients with BCP after RP and no studies that compare patients with BCP and BCR. We evaluate clinical and pathologic characteristics, predictors, and outcomes of patients with BCP vs. BCR in a large contemporary cohort of patients treated with RP. METHODS: From 2001–2008, 4047 patients underwent robotassisted RP (RARP) for localized prostate cancer at a single institution. After excluding 336 patients who were lost to follow up, there were 3711 patients evaluable for the study. BCR was defined as a PSA 0.2 ng/ml with a confirmatory value. BCP was defined as a detectable PSA at the first postoperative draw within 3 months of surgery. Patients with BCP and BCR were compared and multivariable regression analysis was used to identify factors predicting BCP and metastasis. RESULTS: A total of 345 (9.2%) patients had a detectable PSA at a mean follow up of 33.4 months, of whom 114 (33%) had BCP and 231 (67%) had BCR. Patients with a BCP had a significantly higher preoperative PSA (11.7 vs. 8.3), biopsy high-grade disease (36 vs. 21%), biopsy perineural invasion (35 vs. 21%), final pathologic highgrade disease (58 vs. 29%), tumor volume (32 vs. 26%), pathologic angiolymphatic invasion (26 vs. 14%), seminal vesicle invasion (32 vs. 16%), and N1 disease (15 vs. 2.6%). Predictors of BCP on multivariable analysis of all recurrences were biopsy perineural invasion (OR1.8, 95% CI1.02 to 3.1, p 0.043), seminal vesicle invasion (OR-2.7, 95% CI1.2 to 6.2, p 0.021), and N1 disease (OR-6.6, 95% CI2 to 21.5, p 0.002). 21 patients developed metastatic disease (BCP 14, BCR 7, p 0.01). Of all patients with post-RARP PSA elevation (BCP and BCR), only BCP (OR-3.2, p 0.022) and high-grade disease (OR2.9, p 0.043) predicted metastasis. CONCLUSIONS: Patients with BCP have more aggressive disease on biopsy and pathology than patients with BCR and are more likely to develop distant metastasis. Only higher pathologic stage predicts BCP over BCR. Of all patients with a post-RARP PSA elevation, only BCP and Gleason 8 disease predicts metastasis.