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Biochemical outcome after radical prostatectomy among men with normal preoperative serum prostate‐specific antigen levels
Author(s) -
Freedland Stephen J.,
Aronson William J.,
Kane Christopher J.,
Terris Martha K.,
Presti Joseph C.,
Trock Bruce,
Amling Christopher L.
Publication year - 2004
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.20390
Subject(s) - medicine , prostatectomy , prostate cancer , prostate specific antigen , urology , prostate , biochemical recurrence , lymph node , proportional hazards model , biopsy , incidence (geometry) , cancer , gynecology , gastroenterology , physics , optics
BACKGROUND Recent studies have shown that a significant number of men with normal prostate‐specific antigen (PSA) levels have prostate carcinoma. Whether malignancies in such men are associated with better outcomes is unclear. The authors compared the risk of biochemical failure after radical prostatectomy (RP) between men with normal PSA levels and men with elevated PSA levels. METHODS Data were examined from 1582 men who underwent RP between 1988 and 2002 at 1 of 5 equal‐access medical centers. Patients were segregated into groups based on serum PSA levels (with stratification according to age‐specific reference ranges). Clinical and pathologic characteristics and biochemical outcome data were compared across groups using analyses of variance, log‐rank tests, and Cox proportional hazards analysis. RESULTS Men who had normal PSA levels had significantly fewer high‐grade tumors compared with men who had higher PSA levels ( P < 0.001). The former group had a significantly decreased incidence of positive surgical margins, extracapsular disease, seminal vesicle invasion, and lymph node involvement ( P < 0.001). On multivariate analysis, only serum PSA level ( P < 0.001) and biopsy Gleason score ( P < 0.001) predicted the time to disease recurrence. When only men with serum PSA levels < 10 ng/mL were examined, PSA level treated as a continuous variable remained a significant predictor of time to biochemical failure ( P = 0.02). CONCLUSIONS Men who had normal PSA levels had significantly fewer high‐grade tumors and significantly better biochemical outcomes after undergoing RP compared with men who had elevated PSA levels. Overall, men with normal PSA levels who undergo RP represent a favorable risk group. Cancer 2004. © 2004 American Cancer Society.