Persistent Prostate-Specific Antigen After Radical Prostatectomy and Its Impact on Oncologic Outcomes.
Eur Urol
; 76(1): 106-114, 2019 07.
Article
en En
| MEDLINE
| ID: mdl-30772034
ABSTRACT
BACKGROUND:
Persistent prostate-specific antigen (PSA) represents a poor prognostic factor for recurrence after radical prostatectomy (RP).OBJECTIVE:
To investigate the impact of persistent PSA at 6wk after RP on long-term oncologic outcomes and to assess patient characteristics associated with persistent PSA. DESIGN, SETTING, ANDPARTICIPANTS:
Within a high-volume center database we identified patients who harbored persistent (≥0.1ng/ml) versus undetectable PSA (<0.1ng/ml) at 6wk after RP. Patients with neo- and/or adjuvant androgen-deprivation therapy (ADT) were excluded. OUTCOME MEASUREMENTS AND STATISTICALANALYSIS:
Logistic regression models tested for prediction of persistent PSA. Kaplan-Meier analyses and Cox regression models tested the effect of persistent PSA on metastasis-free survival (MFS), overall survival (OS), and cancer-specific survival (CSS) rates. Propensity score matching (PSM) was performed to test the impact of salvage radiotherapy (SRT) on OS and CSS in patients with persistent PSA. RESULTS ANDLIMITATIONS:
Of 11 604 identified patients, 8.8% (n=1025) harbored persistent PSA. At 15yr after RP, MFS, OS, and CSS were 53.0% versus 93.2% (p<0.001), 64.7% versus 81.2% (p<0.001), and 75.5% versus 96.2% (p<0.001) for persistent versus undetectable PSA, respectively. In multivariable Cox regression models, persistent PSA represented an independent predictor for metastasis (hazard ratio [HR] 3.59, p<0.001), death (HR 1.86, p<0.001), and cancer-specific death (HR 3.15, p<0.001). SRT was associated with improved OS (HR 0.37, p=0.02) and CSS (HR 0.12, p<0.01) after 11 PSM. Main limitation is missing data on postoperative PSA and duration of salvage ADT.CONCLUSIONS:
Persistent PSA is associated with worse oncologic outcome after RP, namely, metastasis, death, and cancer-specific death. In patients with persistent PSA, SRT resulted in improved OS and CSS. PATIENTSUMMARY:
We assessed the impact of persistent prostate-specific antigen (PSA) at 6wk after radical prostatectomy on oncologic outcomes. Early persistent PSA was associated with worse metastasis-free survival, overall survival, and cancer-specific survival. Salvage radiotherapy may result in a survival benefit in well-selected patients.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Neoplasias de la Próstata
/
Antígeno Prostático Específico
Tipo de estudio:
Prognostic_studies
Límite:
Aged
/
Humans
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Male
/
Middle aged
Idioma:
En
Revista:
Eur Urol
Año:
2019
Tipo del documento:
Article
País de afiliación:
Alemania