Impact of preoperative serum PSA level from 0 to 10 ng/ml on pathological findings and disease‐free survival after radical prostatectomy

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.