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Prognostic value of modeled PSA clearance on biochemical relapse free survival after radical prostatectomy
Author(s) -
You Benoit,
Girard Pascal,
Paparel Philippe,
Freyer Gilles,
Ruffion Alain,
Charrié Anne,
Hénin Emilie,
Tod Michel,
Perrin Paul
Publication year - 2009
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.20978
Subject(s) - prostatectomy , medicine , prostate cancer , urology , multivariate analysis , proportional hazards model , prostate specific antigen , biochemical recurrence , stage (stratigraphy) , population , univariate analysis , univariate , oncology , multivariate statistics , cancer , paleontology , statistics , mathematics , environmental health , biology
Abstract PURPOSES Using population kinetic approach, we modeled PSA decline equations in patients with prostate cancer after radical prostatectomy (RP). We looked for relationships between early PSA decrease profile, characterized by PSA clearance (CL PSA ) or half‐life (HL PSA ), and the 2‐year biochemical relapse free survival (bRFS). PATIENTS AND METHODS We performed a retrospective study on 55 patients treated with RP and with at least 2 PSA measurements in the post‐operative month. A population kinetic model was investigated with NONMEM®. The prognostic factors regarding bRFS were assessed using univariate and multivariate analyses. RESULTS The best model describing the PSA post‐operative decrease was bi‐compartmental and fit patient data well. Median CL PSA was 0.034 (terciles were 0.023 and 0.048). The significant prognostic factors associated with a better bRFS with univariate analysis were lower CL PSA terciles (2‐year bRFS = 100% vs. 85.1% vs. 66.7% if CL PSA < 0.023, 0.023 ≤ CL PSA < 0.048 or CL PSA ≥ 0.0480, P = 0.006) as well as initial PSA < 7 ng/ml, pT2 stage (vs. pT3), pN0 (vs. pN1) and low main Gleason score (3/5 vs. 4/5). Among these factors, CL PSA was the only independent prognostic factor with multivariate analysis regarding bRFS (HR = 0.92, 95%CI = [0.86–0.98], P = 0.0088). CONCLUSION CL PSA determined with 4 PSA concentrations in the first month following the RP may predict the biochemical relapse risk of prostate cancer patients, thus enabling early identification of high‐risk patients requiring adjuvant treatment. A prospective validation of these results is required. Prostate 69:1325–1333, 2009. © 2009 Wiley‐Liss, Inc.