Pre-prostatectomy PSA Level Is Prognostic For Predicting Biochemical Failure After Surgery

UroToday.com - The clinical utility of PSA has come into question regarding its ability to diagnose clinically significant prostate cancer (CaP) as opposed to BPH. In the May 2006 issue of the Journal of Urology, Dr. Mitchell and colleagues at Columbia University report that pre-operative PSA is predictive of biochemical failure (BCF) following radical prostatectomy (RP) over a 15-year period.

A database search resulted in analysis of 1,246 patients who had RP and bilateral pelvic lymph node dissection. Clinicopathologic variables were compared across 3 time periods; 1988-1993, 1994-1998, and 1999-2003. Patients who received adjuvant therapy were excluded.

Median pre-op PSA was 9.0ng/ml in the early group compared to 5.5ng/ml in the most recent group. Over time, fewer men experienced BCF; 35% in the first group compared to 8% in the recent group.

Univariate analysis demonstrated that PSA, pathological Gleason score and pathologic stage were predictive of BCF across all 3-time periods. Multivariate modeling demonstrated that the impact of PSA in predicting the hazard of BCF did not change from 1988 to 2003. These data support pre-biopsy PSA as significant for predicting BCF following RP.

By Christopher P. Evans, M.D.

J. Urol 2006;175:1663-1667
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