Prostate-specific antigen screening impacts on biochemical recurrence in patients with clinically localized prostate cancer.

Abstract

To clarify the impact of prostate-specific antigen screening on surgical outcomes of prostate cancer. Patients who underwent radical prostatectomy were divided into two groups according to prostate-specific antigen testing opportunity (group1, prostate-specific antigen screening; group2, non-prostate-specific antigen screening). Perioperative clinical characteristics were compared using the Wilcoxon rank-sum and χ2 -tests. Cox proportional hazards models were used to identify independent predictors of postoperative biochemical recurrence-free survival. In total, 798 patients (63.2%) and 464 patients (36.8%) were categorized into groups1 and 2, respectively. Group2 patients were more likely to have a higher prostate-specific antigen level and age at diagnosis and larger prostate volume. Clinical Tstage, percentage of positive cores and pathological Gleason score did not differ between the groups. The 5-year biochemical recurrence-free survival rate was 83.9% for group1 and 71.0% for group2 (P<0.001). On multivariate analysis, prostate-specific antigen testing opportunity (hazard ratio 2.530; P<0.001) was an independent predictive factor for biochemical recurrence after surgery, as well as pathological Tstage, pathological Gleason score, positive surgical margin and lymphovascular invasion. Additional analyses showed that prostate-specific antigen screening had a greater impact on biochemical recurrence in a younger patients, patients with a high prostate-specific antigen level, large prostate volume and D'Amico high risk, and patients meeting the exclusion criteria of the Prostate Cancer Research International Active Surveillance study. Detection by screening results in favorable outcomes after surgery. Prostate-specific antigen screening might contribute to reducing biochemical recurrence in patients with localized prostate cancer.