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Impact of preoperative serum PSA level from 0 to 10 ng/ml on pathological findings and disease‐free survival after radical prostatectomy
Author(s) -
Shekarriz Bijan,
Upadhyay Jyoti,
Bianco Fernando J.,
Tefilli Marcos V.,
Tiguert Rabi,
Gheiler Edward L.,
Grig David J.,
Pontes J. Edson,
Wood David P.
Publication year - 2001
Publication title -
the prostate
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.295
H-Index - 123
eISSN - 1097-0045
pISSN - 0270-4137
DOI - 10.1002/pros.1092
Subject(s) - medicine , prostatectomy , urology , prostate cancer , prostate specific antigen , pathological , stage (stratigraphy) , cohort , prostate , cancer , gastroenterology , surgery , paleontology , biology
Background To determine the impact of various preoperative serum prostate specific antigen (PSA) levels in the range from 0.1 to 10 ng/ml on pathological stage and disease‐free survival after radical prostatectomy. Methods We selected a cohort of 585 patients who underwent radical prostatectomy between 1991–1996 for clinically localized prostate cancer and presented with preoperative serum PSA levels from 0.1 to 10 ng/ml. Results Pathological organ‐confined disease was present in 57.6% of patients. The rate of organ‐confined disease decreased from an average of 85% for patients with a PSA value < 2 ng/ml, to 46.8% for patients with a PSA value > 7 ng/ml. We found statistically significant correlations between preoperative serum PSA level and overall pathological stage ( P = 0.001), pathologically organ‐confined disease ( P = 0.001), margin positive rates ( P = 0.001), extra prostatic extension ( P = 0.001), and seminal vesicle invasion ( P = 0.001). The overall disease‐free survival rate was 87%, with a median follow up of 42.4 months. Disease free survival was significantly better for patients with PSA up to 4 ng/ml ( P = 0.005). Conclusions Our data suggests that PSA detection programs should strive to detect prostate cancer in men before the PSA level rises above 7 ng/ml. In addition, since patients with a PSA level < 4 ng/ml had better disease‐free survival rates than those with a PSA level between 4.1–10 ng/ml, eliminating an arbitrary cutoff of 4 ng/ml, may lead to improved disease‐free survival. Prostate 48:136–143, 2001. © 2001 Wiley‐Liss, Inc.