Prostate-specific antigen density as a predictor of biochemical failure following radical prostatectomy.

Abstract

Abstract. In Russia, prostate cancer is one of the most common cancers in men. Radical prostatectomy is an established option to treat localized prostate cancer. Almost 35% of patients will face prostate cancer progression within 10 years following radical prostatectomy. Purpose. To assess the ability of PSA density to predict biochemical relapse and detect unfavorable pathological features among patients suffering from localized prostate cancer treated with radical prostatectomy. Material and methods. The study evaluated 147 patients with localized prostate cancer who underwent an open or laparoscopic retropubic radical prostatectomy between February 2001 and August 2015. The assessment of prognostic and clinical significance of PSA density took place. Results. Biochemical recurrence was observed in 53 (36.01%) patients. PSA density (p = 0.006), Gleason score (p = 0.0006), pathological stage T (p = 0.002), extraprostatic extension (p = 0.019), seminal vesicle invasion (p = 0.001) and prostate cancer upstaging (p=0.0007) were found to significantly correlate with biochemical relapse risk. We established a relationship between PSA density and unfavorable pathological features detection following radical prostatectomy. Using ROC – curve analysis (AUC=0,635, р=0,005) we determined PSA density threshold of (>0,309 ng/mL/cc) – when exceeded, was associated with statistically significant decrease in disease – free survival. According to the results of multivariate analysis – PSA density, abnormal Gleason score and seminal vesicle invasion has proven to influence disease – free survival (p < 0.05). Conclusion. We have clearly demonstrated a PSA density as an important prognostic tool of high clinical relevance, which may aid in biochemical relapse risk estimation. A PSA density parameter incorporation into preoperative nomograms may increase the predictive potential of latter.