First Postprostatectomy Ultrasensitive Prostate-specific Antigen Predicts Survival in Patients with High-risk Prostate Cancer Pathology

Kang, Jung Julie; Reiter, Robert E.; Steinberg, Michael L.; King, Christopher R.

doi:10.1016/j.euo.2018.07.008

Cited by 6 publications

(9 citation statements)

References 33 publications

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“…There are reports that the PSA value measured at a certain time after RP is associated with the risk of developing BCR [21][22][23]. Kang et al reported that a PSA value greater than 0.03 ng/ mL at 3 months after RP increases the risk of BCR [23].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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“…However, it is important to underline that our analysis was adjusted for the year of surgery and, furthermore, that all postoperative RT was performed at single referral center, thus eliminating the variability in RT technique which may exists between different centers. Third, the impact of the progressive introduction of new imaging modalities such as prostate-specific membrane antigen-based PET/CT scan 26,27 for detection of recurrence, as well as the use of ultrasensitive methods for post-prostatectomy PSA dosage, 28 were not accounted for in the current analysis. Lastly, the institutional data set lacks detailed information of HT type and duration.…”

Section: Discussionmentioning

confidence: 99%

Not All Adverse Pathology Features Are Equal: Identifying Optimal Candidates for Adjuvant Radiotherapy Among Patients With Adverse Pathology at Radical Prostatectomy

et al. 2022

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Purpose:Recent studies reported a potential benefit associated with adjuvant radiotherapy for patients with adverse pathology features of prostate cancer. We hypothesized that not all the patients with adverse features may benefit from adjuvant radiotherapy and, therefore, observation ± early salvage radiotherapy may still be considered in a subgroup of these patients.Materials and Methods:Among 8,362 patients treated with radical prostatectomy at a single center between 1987 and 2020, 926 eligible patients with adverse pathology features (ie, grade group 4-5 with ≥pT3a stage and/or lymph node invasion) were identified. Cox models were used to assign a score to each feature. Patients were then stratified in low-, intermediate-, and high-risk groups, and interaction term analyses tested the impact of adjuvant radiotherapy for each risk subgroup after adjusting for inverse probability of treatment weighting.Results:Overall, 538 (58%) vs 89 (10%) vs 299 (32%) patients received adjuvant radiotherapy vs early salvage radiotherapy vs observation. The 10-year overall survival rate was 90%. A significant interaction between adjuvant radiotherapy and high-risk group was recorded (HR 0.21, P = .04). After risk stratification and propensity-score weighting, survival analyses depicted comparable 10-year overall survival in low- and intermediate-risk patients treated with adjuvant radiotherapy or observation ± early salvage radiotherapy. Conversely, in high-risk patients, adjuvant radiotherapy was associated with significant improvement in 10-year overall survival compared to observation ± early salvage radiotherapy (76% vs 63%, P = .038).Conclusions:Among patients with adverse pathology features, we identified 3 subclassifications of risk. When testing the effect of adjuvant radiotherapy vs observation with or without early salvage radiotherapy on survival, only patients included in the high-risk group seemed to benefit from adjuvant radiotherapy.

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“…22,23 The present study demonstrated that prolonged surgical duration was the only contributing factor for BCR within 12 months after RARP in patients with PSMs. Since increase in the value of PSA in the early postoperative period is reportedly significantly associated with overall survival after radical prostatectomy in patients with PSMs, 24 surgical duration should be minimized as far as possible. In several studies, factors such as high Gleason score in the transition zone, 25 pre-operative PSA level, 26 prostate volume, 27 and pathological stage 26,28 were reported to be significantly associated with PSMs.…”

Section: Discussionmentioning

confidence: 99%

Association Between Surgical Stress and Biochemical Recurrence After Robotic Radical Prostatectomy

Meguro¹,

Haga²,

Imai³

et al. 2021

JSLS

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Background and Objectives: This study was conducted to identify whether surgical stress during the peri-operative period of robot-assisted radical prostatectomy might affect biochemical recurrence in patients with positive surgical margins.Methods: Participants in the present study were 324 consecutive patients with localized prostate cancer who underwent robot-assisted radical prostatectomy between February 2013 and June 2018. Positive surgical margins were diagnosed in 61 of them. Patients with positive surgical margins were divided into those with (n = 19) and those without (n = 42) biochemical recurrence. Lymph node dissection, estimated blood loss, inhalation anesthetic volume, and surgical duration were evaluated as indicators of surgical stress. White blood cell count, C-reactive protein, body temperature, and usage of analgesics were postoperatively evaluated as surrogate markers of surgical stress. The associations between factors, including patients' characteristics and pathological features, and biochemical recurrence were investigated.Results: In univariate analyses, surgical duration (P = 0.004), D'Amico risk class (P = 0.002), Gleason score (P = 0.022) and the number of positive cores in prostate biopsy (P = 0.009) were statistically significantly associated with biochemical recurrence. In multivariate analyses, only surgical duration was significantly associated with biochemical recurrence (P = 0.042), at a cut-off value of surgical duration of 228.5 minutes.Conclusions: Prolonged surgical duration is associated with biochemical recurrence in patients with positive surgical margins. Thus, surgical duration should be limited as much as possible to reduce surgical stress, which might cause biochemical recurrence.

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First Postprostatectomy Ultrasensitive Prostate-specific Antigen Predicts Survival in Patients with High-risk Prostate Cancer Pathology

Cited by 6 publications

References 33 publications

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

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

Not All Adverse Pathology Features Are Equal: Identifying Optimal Candidates for Adjuvant Radiotherapy Among Patients With Adverse Pathology at Radical Prostatectomy

Association Between Surgical Stress and Biochemical Recurrence After Robotic Radical Prostatectomy

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