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Prognostic significance of a novel indicator (PSApostd3/PSApre) for PSA recurrence in patients after radical prostatectomy

Authors Zhou Z, Xu Y, Li Q, Yan W, Zhou Y, Zheng Z, Li H, Ji Z

Received 8 December 2018

Accepted for publication 24 May 2019

Published 25 June 2019 Volume 2019:11 Pages 5777—5783


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Beicheng Sun

Zhien Zhou,1,* Yinyan Xu,2,* Qianyue Li,3 Weigang Yan,1 Yi Zhou,1 Zhibo Zheng,1 Hanzhong Li,1 Zhigang Ji1

1Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China; 2Clinical Medicine School, Peking Union Medical College, Beijing, People’s Republic of China; 3Department of Urology, General Hospital of Xinjiang Production and Construction Corps, Xinjiang, People’s Republic of China

*These authors contributed equally to this work

Purpose: Radical prostatectomy (RP) is a common treatment for prostate cancer, but a fraction of patients may experience PSA recurrence after surgery, manifesting as an elevation in prostate specific antigen (PSA). Vast literature has reported different prognostic factors for PSA recurrence without reaching a consensus. This retrospective study investigated the efficacy of a new indicator in predicting PSA recurrence in patients after RP.
Patients and methods: From October 2000 to December 2015, 102 PCa patients who underwent laparoscopic prostatectomy in the Urology Department of Peking Union Medical College Hospital were analyzed. We calculated PSApostd3/PSApre, defined as the ratio of the PSA on day 3 postop as the numerator and the pre-operative PSA as the denominator, in these patients to represent PSA decrement after surgery, and investigated its relationship with PSA recurrence during follow-up.
Results: The receiver operating characteristic (ROC) curve of PSApostd3/PSApre derived a cut-off at 0.453 (sensitivity=0.704, specificity=0.853, P<0.0001), suggesting an increased risk of PSA recurrence in patients whose PSA on day 3 postop did not decrease to approximately half of their preoperative levels. Among several factors, PSApostd3/PSApre (P<0.0001), pathological T stage (P=0.042) and Gleason Grade (P=0.021) were determined to be significantly associated with PSA recurrence by Fisher’s exact test, while only PSApostd3/PSApre (P<0.001) was significantly related to PSA recurrence-free survival (PRFS) by multivariate logistic regression analysis.
Conclusion: These results imply that PSApostd3/PSApre could provide substantial information for PSA recurrence prediction in patients after RP.

Keywords: prognosis, prostate cancer, prostate-specific antigen

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