Predictive factors and the important role of detectable prostate-specific antigen for detection of clinical recurrence and cancer-specific mortality following robot-assisted radical prostatectomy

Abstract

A detectable PSA is affected by factors associated with aggressive prostate cancer. Within men with persistent PSA, those with higher pathologic stage and who received adjuvant ADT are more likely to have CR. Patients with CR, Gleason ≥ 8, and those who received adjuvant ADT must have a close monitoring due to the high rate of mortality.

The impact of prostate‐specific antigen persistence after radical prostatectomy on the efficacy of salvage radiotherapy in patients with primary N0 prostate cancer

“…On the other hand, matching for these risk factors reduced the impact of the post-RP PSA level. An association of adverse clinicopathological parameters with the post-RP PSA level has been reported in several recent studies, in one instance even with the PSA threshold at 0.01 ng/mL [8,[15][16][17].…”

The Impact of the Percent of Residual Prostate-Specific Antigen on Metastasis-Free Survival in Patients with Persistent Prostate-Specific Antigen after Radical Prostatectomy

“…Conversely, persistent levels of PSA (≥0.1 ng/mL) mean that there is a residual biochemically active tumor burden, regardless of imaging findings [ 4 ]. Therefore, persistent PSA is a poor prognostic factor for recurrence after RP [ 4 5 6 7 8 9 10 11 ].…”

Management of Persistently Elevated Prostate-specific Antigen After Radical Prostatectomy: A Systematic Review of the Literature

“…It clearly depends on the study selection/exclusion criteria and the PSA cutoff used. When considering only the largest series and a PSA threshold of 0.1 ng/ml, which is the most used threshold in the available literature, the proportion of patients having a persistently elevated PSA value ranged from 3.1% to 30% [1,2,6,13,14]. For example, in the subgroup of patients undergoing surgery for high-risk and/or locally advanced disease, up to 30% of men after surgery may have persistently elevated PSA values of !0.2 ng/ml (20%, 25%, and 30% in the ROG 9601, SWOG 8794, and ARO 9602 trials, respectively).…”

“…Immediate ADT has been associated with improved outcomes. Kim et al [11] and García-Barreras et al [13] found that immediate treatment (ADT and/or sRT) improved MFS and CSS in the univariable analysis. Gandaglia et al [23] correlated the use of immediate ADT with improved CSS.…”

“…When compared with patients achieving an undetectable PSA level, patients with persistently elevated PSA were more likely to receive salvage treatments ACM = all-cause mortality; BCRFS = biochemical recurrence-free survival; CSM = cancer-specific mortality; HR = hazard ratio; EPE = extraprostatic extension; MFS = metastasis-free survival; OS = overall survival; PSA = prostate-specific antigen; NS = not significant; PSM = positive surgical margin; RP = radical prostatectomy; RT = radiotherapy; sRT = salvage radiotherapy. 13,18] except in the studies that included only pN1 [11,16] or sRT [1,12,15,17,19] patients. The median pre-sRT PSA level was available in only four studies (from 0.29 to 0.52 ng/ml).…”