Impact of persistent PSA after salvage radical prostatectomy: a multicenter study
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Published:2023-10-06
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Volume:
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ISSN:1365-7852
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Container-title:Prostate Cancer and Prostatic Diseases
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language:en
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Short-container-title:Prostate Cancer Prostatic Dis
Author:
Preisser Felix, Incesu Reha-Baris, Rajwa PawelORCID, Chlosta Marcin, Nohe Florian, Ahmed Mohamed, Abreu Andre LuisORCID, Cacciamani Giovanni, Ribeiro Luis, Kretschmer Alexander, Westhofen Thilo, Smith Joseph A., Steuber Thomas, Calleris GiorgioORCID, Raskin Yannic, Gontero Paolo, Joniau StevenORCID, Sanchez-Salas Rafael, Shariat Shahrokh F., Gill Inderbir, Karnes R. Jeffrey, Cathcart Paul, Van Der Poel Henk, Marra Giancarlo, Tilki DeryaORCID
Abstract
Abstract
Background and objective
Persistent prostatic specific antigen (PSA) represents a poor prognostic factor for recurrence after radical prostatectomy (RP). However, the impact of persistent PSA on oncologic outcomes in patients undergoing salvage RP is unknown. To investigate the impact of persistent PSA after salvage RP on long-term oncologic outcomes.
Material and methods
Patients who underwent salvage RP for recurrent prostate cancer between 2000 and 2021 were identified from twelve high-volume centers. Only patients with available PSA after salvage RP were included. Kaplan-Meier analyses and multivariable Cox regression models were used to test the effect of persistent PSA on biochemical recurrence (BCR), metastasis and any death after salvage RP. Persistent PSA was defined as a PSA-value ≥ 0.1 ng/ml, at first PSA-measurement after salvage RP.
Results
Overall, 580 patients were identified. Of those, 42% (n = 242) harbored persistent PSA. Median follow-up after salvage RP was 38 months, median time to salvage RP was 64 months and median time to first PSA after salvage RP was 2.2 months. At 84 months after salvage RP, BCR-free, metastasis-free, and overall survival was 6.6 vs. 59%, 71 vs. 88% and 77 vs. 94% for patients with persistent vs. undetectable PSA after salvage RP (all p < 0.01). In multivariable Cox models persistent PSA was an independent predictor for BCR (HR: 5.47, p < 0.001) and death (HR: 3.07, p < 0.01).
Conclusion
Persistent PSA is common after salvage RP and represents an independent predictor for worse oncologic outcomes. Patients undergoing salvage RP should be closely monitored after surgery to identify those with persistent PSA.
Publisher
Springer Science and Business Media LLC
Subject
Cancer Research,Urology,Oncology
Reference24 articles.
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