Adverse pathology and undetectable ultrasensitive prostate-specific antigen after radical prostatectomy

Is adjuvant radiation warranted?

Ross M. Simon, Lauren E. Howard, Stephen J. Freedland, William J. Aronson, Martha Kennedy Terris, Christopher J. Kane, Christopher L. Amling, Matthew R. Cooperberg, Adriana C. Vidal

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objectives To determine if men with adverse pathology but undetectable ultrasensitive (<0.01 ng/mL) PSA are at high-risk for biochemical recurrence (BCR), or if there is a subset of patients at low-risk for whom the benefit of adjuvant radiation therapy might be limited. Patients and Methods We evaluated 411 patients treated with RP from 2001 to 2013 without adjuvant radiation who had an undetectable (<0.01 ng/mL) PSA level after RP but with adverse pathology [positive surgical margins (PSMs), extraprostatic extension (EPE), and/or seminal vesicle invasion (SVI)]. Multivariable Cox regression analyses tested the relationship between pathological characteristics and BCR to identify groups of men at highest risk of early BCR. Results On multivariable analysis, only pathological Gleason 7 (4 + 3), Gleason ≥8, and SVI independently predicted BCR (P = 0.019, P < 0.001, and P = 0.001, respectively), although on two-way analysis men with Gleason 7 (4 + 3) did not have significantly higher rates of BCR compared with patients with Gleason ≤6 (log-rank, P = 0.074). Men with either Gleason ≥8 (with PSMs or EPE) or SVI (15% of the cohort) defined a high-risk group vs men without these characteristics (3-year BCR risk of 50.4% vs 11.9%, log-rank, P < 0.001). Conclusions Among men with adverse pathology but an undetectable (<0.01 ng/mL) PSA level after RP, the benefits of adjuvant radiation are probably limited except for men with Gleason 8-10 (with PSMs or EPE) or SVI who are at high-risk of early BCR.

Original languageEnglish (US)
Pages (from-to)897-903
Number of pages7
JournalBJU International
Volume117
Issue number6
DOIs
StatePublished - Jun 1 2016

Fingerprint

Prostate-Specific Antigen
Prostatectomy
Radiation
Pathology
Seminal Vesicles
Recurrence
Radiotherapy
Regression Analysis
Margins of Excision

Keywords

  • adjuvant radiotherapy
  • prostate
  • prostate-specific antigen
  • prostatic neoplasm
  • recurrence

ASJC Scopus subject areas

  • Urology

Cite this

Adverse pathology and undetectable ultrasensitive prostate-specific antigen after radical prostatectomy : Is adjuvant radiation warranted? / Simon, Ross M.; Howard, Lauren E.; Freedland, Stephen J.; Aronson, William J.; Terris, Martha Kennedy; Kane, Christopher J.; Amling, Christopher L.; Cooperberg, Matthew R.; Vidal, Adriana C.

In: BJU International, Vol. 117, No. 6, 01.06.2016, p. 897-903.

Research output: Contribution to journalArticle

Simon, RM, Howard, LE, Freedland, SJ, Aronson, WJ, Terris, MK, Kane, CJ, Amling, CL, Cooperberg, MR & Vidal, AC 2016, 'Adverse pathology and undetectable ultrasensitive prostate-specific antigen after radical prostatectomy: Is adjuvant radiation warranted?', BJU International, vol. 117, no. 6, pp. 897-903. https://doi.org/10.1111/bju.13182
Simon, Ross M. ; Howard, Lauren E. ; Freedland, Stephen J. ; Aronson, William J. ; Terris, Martha Kennedy ; Kane, Christopher J. ; Amling, Christopher L. ; Cooperberg, Matthew R. ; Vidal, Adriana C. / Adverse pathology and undetectable ultrasensitive prostate-specific antigen after radical prostatectomy : Is adjuvant radiation warranted?. In: BJU International. 2016 ; Vol. 117, No. 6. pp. 897-903.
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title = "Adverse pathology and undetectable ultrasensitive prostate-specific antigen after radical prostatectomy: Is adjuvant radiation warranted?",
abstract = "Objectives To determine if men with adverse pathology but undetectable ultrasensitive (<0.01 ng/mL) PSA are at high-risk for biochemical recurrence (BCR), or if there is a subset of patients at low-risk for whom the benefit of adjuvant radiation therapy might be limited. Patients and Methods We evaluated 411 patients treated with RP from 2001 to 2013 without adjuvant radiation who had an undetectable (<0.01 ng/mL) PSA level after RP but with adverse pathology [positive surgical margins (PSMs), extraprostatic extension (EPE), and/or seminal vesicle invasion (SVI)]. Multivariable Cox regression analyses tested the relationship between pathological characteristics and BCR to identify groups of men at highest risk of early BCR. Results On multivariable analysis, only pathological Gleason 7 (4 + 3), Gleason ≥8, and SVI independently predicted BCR (P = 0.019, P < 0.001, and P = 0.001, respectively), although on two-way analysis men with Gleason 7 (4 + 3) did not have significantly higher rates of BCR compared with patients with Gleason ≤6 (log-rank, P = 0.074). Men with either Gleason ≥8 (with PSMs or EPE) or SVI (15{\%} of the cohort) defined a high-risk group vs men without these characteristics (3-year BCR risk of 50.4{\%} vs 11.9{\%}, log-rank, P < 0.001). Conclusions Among men with adverse pathology but an undetectable (<0.01 ng/mL) PSA level after RP, the benefits of adjuvant radiation are probably limited except for men with Gleason 8-10 (with PSMs or EPE) or SVI who are at high-risk of early BCR.",
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T1 - Adverse pathology and undetectable ultrasensitive prostate-specific antigen after radical prostatectomy

T2 - Is adjuvant radiation warranted?

AU - Simon, Ross M.

AU - Howard, Lauren E.

AU - Freedland, Stephen J.

AU - Aronson, William J.

AU - Terris, Martha Kennedy

AU - Kane, Christopher J.

AU - Amling, Christopher L.

AU - Cooperberg, Matthew R.

AU - Vidal, Adriana C.

PY - 2016/6/1

Y1 - 2016/6/1

N2 - Objectives To determine if men with adverse pathology but undetectable ultrasensitive (<0.01 ng/mL) PSA are at high-risk for biochemical recurrence (BCR), or if there is a subset of patients at low-risk for whom the benefit of adjuvant radiation therapy might be limited. Patients and Methods We evaluated 411 patients treated with RP from 2001 to 2013 without adjuvant radiation who had an undetectable (<0.01 ng/mL) PSA level after RP but with adverse pathology [positive surgical margins (PSMs), extraprostatic extension (EPE), and/or seminal vesicle invasion (SVI)]. Multivariable Cox regression analyses tested the relationship between pathological characteristics and BCR to identify groups of men at highest risk of early BCR. Results On multivariable analysis, only pathological Gleason 7 (4 + 3), Gleason ≥8, and SVI independently predicted BCR (P = 0.019, P < 0.001, and P = 0.001, respectively), although on two-way analysis men with Gleason 7 (4 + 3) did not have significantly higher rates of BCR compared with patients with Gleason ≤6 (log-rank, P = 0.074). Men with either Gleason ≥8 (with PSMs or EPE) or SVI (15% of the cohort) defined a high-risk group vs men without these characteristics (3-year BCR risk of 50.4% vs 11.9%, log-rank, P < 0.001). Conclusions Among men with adverse pathology but an undetectable (<0.01 ng/mL) PSA level after RP, the benefits of adjuvant radiation are probably limited except for men with Gleason 8-10 (with PSMs or EPE) or SVI who are at high-risk of early BCR.

AB - Objectives To determine if men with adverse pathology but undetectable ultrasensitive (<0.01 ng/mL) PSA are at high-risk for biochemical recurrence (BCR), or if there is a subset of patients at low-risk for whom the benefit of adjuvant radiation therapy might be limited. Patients and Methods We evaluated 411 patients treated with RP from 2001 to 2013 without adjuvant radiation who had an undetectable (<0.01 ng/mL) PSA level after RP but with adverse pathology [positive surgical margins (PSMs), extraprostatic extension (EPE), and/or seminal vesicle invasion (SVI)]. Multivariable Cox regression analyses tested the relationship between pathological characteristics and BCR to identify groups of men at highest risk of early BCR. Results On multivariable analysis, only pathological Gleason 7 (4 + 3), Gleason ≥8, and SVI independently predicted BCR (P = 0.019, P < 0.001, and P = 0.001, respectively), although on two-way analysis men with Gleason 7 (4 + 3) did not have significantly higher rates of BCR compared with patients with Gleason ≤6 (log-rank, P = 0.074). Men with either Gleason ≥8 (with PSMs or EPE) or SVI (15% of the cohort) defined a high-risk group vs men without these characteristics (3-year BCR risk of 50.4% vs 11.9%, log-rank, P < 0.001). Conclusions Among men with adverse pathology but an undetectable (<0.01 ng/mL) PSA level after RP, the benefits of adjuvant radiation are probably limited except for men with Gleason 8-10 (with PSMs or EPE) or SVI who are at high-risk of early BCR.

KW - adjuvant radiotherapy

KW - prostate

KW - prostate-specific antigen

KW - prostatic neoplasm

KW - recurrence

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