Biochemical recurrence after radical prostatectomy according to nadir prostate specific antigen value.

Jae Hoon Chung,Minyong Kang,Hyun Moo Lee,Byong Chang Jeong,Ji Youl Lee,Seong Il Seo,Was Song,Hyun Hwan Sung,Jae Yong Jeong,Hwang Gyun Jeon,Seong Soo Jeon,Henry Woo

doi:10.1371/journal.pone.0249709

Abstract

The hypersensitive prostate specific antigen (PSA) test can measure in 0.01 ng/mL units, and its efficacy for screening after radical prostatectomy (RP) has been reported. In this study, we assessed patients who underwent RP to evaluate whether the nadir value affects biochemical recurrence (BCR). From 1995 to 2014, patients classified as N0 who had negative resection margins and a nadir PSA of less than 0.2 ng/mL were evaluated. The characteristics, pathological outcomes, PSA after RP, and BCR were assessed. A total of 1483 patients were enrolled. Among them, 323 (21.78%) patients showed BCR after RP. The mean age of the BCR group was 63.86±7.31 years, and while that of the no-recurrence group was 64.06±6.82 years (P = 0.645). The mean preoperative PSA of the BCR group was 9.75±6.92 ng/mL and that of the no-recurrence group was 6.71±5.19 ng/mL (P < 0.001). The mean time to nadir (TTN) in the BCR group was 4.64±7.65 months, while that in the no-recurrence group was 7.43±12.46 months (P < 0.001). The mean PSA nadir value was 0.035±0.034 ng/mL in the BCR group and 0.014±0.009 ng/mL in the no-recurrence group (P < 0.001). In multivariable Cox regression analyses, Gleason score, positive biopsy core percentages, minimal invasive surgery, nadir PSA value, and TTN were independently associated with BCR. The mean BCR occurred at 48.23±2.01 months after RP, and there was a significant difference in BCR occurrence according to the nadir PSA value (P < 0.001). A high PSA nadir value and short TTN may predict the risk of BCR after successful RP, aiding the identification of candidates for adjuvant or salvage therapies after RP.

Highlights

Recent advances in urology have led to better surgical candidate selection and advances in surgical technology, but biochemical recurrence (BCR) still occurs in 15–40% of patients after radical prostatectomy (RP) for the treatment of prostate cancer (PCa) [1]
In terms of baseline characteristics, there was no significant difference in age, body mass index (BMI), or diabetes mellitus (DM) between the BCR and non-BCR groups, but HTN was 27.55% in the BCR group and 32.41% in the non-BCR group (P = 0.019)
The BCR group showed significant differences in pre-operative parameters including pre-operative prostate specific antigen (PSA), PSA density (PSAD), biopsy Gleason scores, positive core percentages, tumor volume percentages, and clinical stage compared to the non-BCR group (Table 1)

Summary

Introduction

Recent advances in urology have led to better surgical candidate selection and advances in surgical technology, but biochemical recurrence (BCR) still occurs in 15–40% of patients after radical prostatectomy (RP) for the treatment of prostate cancer (PCa) [1]. This BCR is associated with disease progression and cancer-specific mortality in PCa patients [2]. Ultrasensitive PSA tests have been reported to predict the biochemical recurrence after RP [11,12,13]. Other studies have reported that ultrasensitive PSA tests onl provide cause PCa patients anxiety without clinical significance [14]

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Conclusion