The Use of Early Postoperative Prostate-specific Antigen to Stratify Risk in Patients With Positive Surgical Margins After Radical Prostatectomy

Stepan Vesely; Ladislav Jarolim; Katerina Duskova; Marek Schmidt; Pavel Dusek; Marko Babjuk

BMC Urol. 2014;14(79)

Conclusions

The present study provides insights into the role ultrasensitive serum PSA measurements plays in determining who will develop BCR after radical prostatectomy and, such as, be candidates for secondary treatment. The kinetics of postoperative PSA decline may allow better stratification of patients who would benefit from immediate radiation therapy.

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Abbreviations
PSM: Positive surgical margins; RP: Radical prostatectomy; PSA: Prostate-specific antigen; BCR: Biochemical recurrence; AUC: Area under the curve; HR: Hazard ratio; ROC: Receiver operating characteristic curve.

Competing interests
The authors declare that they have no competing interests.

Authors' contributions
SV designed the study, collected and analyzed data, wrote and drafted the manuscript, LJ was involved in revising the manuscript critically for important intellectual content, KD collected the follow-up data and contributed to conception and design, MS drafted the manuscript, PD made the contribution to acquisition of data, MB made substantial contributions All authors read and approved the manuscript.

Acknowledgements
Supported by the project (Ministry of Health, Czech Republic) for conceptual development of research organization 00064203 (University Hospital Motol, Prague, Czech Republic).

Table 1. Differences in potential predictive parameters according to the appearance of BCR
Parameters	BCR	BCR-free	p value
n	55	61
Pre-operative PSA (ng/ml, range)	9.20 (2.85–38.20)	7.60 (3.08–59.7)	0.172
Pathologic Gleason sum ≥ 7	27 (49.1%)	32 (52.5%)	0.717
Pathologic extraprostatic extension	25 (45.5%)	26 (42.6%)	0.393
Seminal vesicle invasion	8 (14.5%)	3 (5%)	0.077
PSA – day 14 (ng/ml, range)	0.298 (0.071–1.940)	0.238 (0.045–3.020)	0.264
PSA – day 30 (ng/ml, range)	0.085 (0.008–0.747)	0.022 (0.003–0.692)	<0.0001
PSA – day 60 (ng/ml, range)	0.041 (0.003–0.882)	0.010 (0.003–0.618)	<0.0001
PSA – day 90 (ng/ml, range)	0.042 (0.003–1.010)	0.008 (0.003–0.853)	<0.0001
PSA – day 180 (ng/ml, range)	0.013 (0.015–1.167)	0.011 (0.003–0.931)	<0.0001
PSA nadir (ng/ml, range)	0.022 (0.003–0.137)	0.007 (0.003–0.039)	<0.0001
Time to PSA nadir (months, range)	2 (0.5–3)	2 (1–12)	0.005

BCR, biochemical recurrence; PSA, prostate specific antigen;
Data presented as n (%) or median (range).

Table 2. Cox regression analyses of PSA cut-offs at particular postoperative measurement day as a predictor of BCR
Parameters	Hazard ratio	p value
PSA – day 14 (0.707 ng/ml)	2.60 (1.24–5.56)	0.133
PSA – day 30 (0.073 ng/ml)	4.35 (2.39–8.06)	<0.001
PSA – day 60 (0.041 ng/ml)	9.59 (5.15–17.95)	<0.001
PSA – day 90 (0.012 ng/ml)	12.34 (4.98–41.09)	<0.001
PSA – day 180 (0.021 ng/ml)	12.85 (6.29–29.82)	<0.001

BCR, biochemical recurrence; PSA, prostate specific antigen; PSM, positive surgical margins.
Data presented as PSA-measurement day (cut-off value) and hazard ratio (95% confidence interval).