Prognostic Impact of Time to Undetectable Prostate-Specific Antigen in Patients with Positive Surgical Margins Following Radical Prostatectomy

Kyo Chul Koo, Patrick Tuliao, Christos Komninos, Young Deuk Choi, Byung Ha Chung, Sung Joon Hong, Sun Ha Jee, Koon Ho Rha

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background: The purpose of this article was to determine the impact of time to undetectable prostate-specific antigen (PSA) for predicting biochemical recurrence (BCR) in patients with a positive surgical margin (PSM) following radical prostatectomy (RP). A PSM is an independent predictor of BCR; however, not all patients develop BCR later on.

Methods: A retrospective analysis was conducted on 1,117 consecutive prostate cancer patients who underwent RP without neoadjuvant or adjuvant therapy from July 2005 to December 2009. Of these, 516 (46.2 %) patients without PSMs, and 214 (19.2 %) patients with PSMs who later achieved undetectable PSA, defined as <0.01 ng/ml, were identified. Patients with PSMs were stratified according to time to undetectable PSA dichotomized at 6 weeks and compared with patients without PSMs. Patients with PSMs who did not achieve undetectable PSA were excluded. BCR was defined as two consecutive increases of post-undetectable PSA ≥0.2 ng/ml.

Results: During the median follow-up of 58.2 months, patients with PSMs who achieved undetectable PSA in <6 weeks had comparable 5-year BCR-free survival rates to those without PSMs; however, patients with PSMs who achieved undetectable PSA in ≥6 weeks showed significantly lower rates compared with both patients without PSMs (59.2 vs 74.3 %; p < 0.001) and patients with PSMs who achieved undetectable PSA in <6 weeks (59.2 vs 78.8 %; p = 0.004). Among patients with PSMs, multivariate analysis revealed time to undetectable PSA at ≥6 weeks and seminal vesicle invasion to be independent predictors of BCR. No perioperative factors were associated with undetectable PSA at ≥6 weeks.

Conclusions: Patients with PSMs who achieve undetectable PSA in <6 weeks show comparable risks of BCR to patients with negative surgical margins.

Original languageEnglish
Pages (from-to)693-700
Number of pages8
JournalAnnals of surgical oncology
Volume22
Issue number2
DOIs
Publication statusPublished - 2015 Jan 1

All Science Journal Classification (ASJC) codes

  • Surgery
  • Oncology

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