Pre-treatment PSA velocity (PSAV) is not predictive of outcomes after radical prostatectomy (RP) in a referral cohort

Abstract

4619 Background: PSA velocity has recently been reported as a significant predictor of prostate cancer-specific mortality in early-staged cancer patients selected from a large screening trial where the median PSA was 4.3ng/ml. In order to determine the broad applicability of these data to a more general population, we examined the effect of PSAV in a referral cohort. Methods: We analyzed over 643 prostate cancer cases diagnosed from 1995–2005. 196 patients underwent RP as definitive therapy. One patient received neoadjuvant hormonal therapy and was excluded. Our goal was to identify whether PSAV prior to RP was predictive of Relapse-Free Survival (RFS) and Overall Survival (OS). 156 patients had at least 2 pre-op PSA values available for the calculation of PSAV (median = 3 values/patient). PSAV was calculated by linear regression analysis using all pre-treatment PSA values available. Results: With a median f/u of 54 months, there were 14 deaths and 26 patients had biochemical relapse. At 5 years, OS was 93% and RFS was 91%. Surprisingly, no patients with biochemical relapse have died, and thus prostate cancer-specific mortality is 0%. In addition to the variables in the table below, seminal vesicle involvement (p = 0.015) and margin positivity (p=0.005) were also significantly associated with RFS confirming the expected prognostic factors in our cohort. On multivariate analysis, Gleason Grade was the only significant predictor of overall survival. For RFS, Gleason Grade, margin involvement, and pre-treatment PSAs were the only significant variables. Neither PSAV nor PSA Doubling Time were significantly associated with RFS or OS by univariate or multivariate analysis. Conclusions: Pre-treatment PSAV is not significantly associated with prostate cancer outcomes in a heterogenous population referred for an elevated PSA. Gleason Grade is still the most significant predictor of overall survival. [Table: see text] No significant financial relationships to disclose.