First postoperative PSA is associated with outcomes in patients with node positive prostate cancer

Results from the SEARCH database

Michelle L. McDonald, Lauren E. Howard, William J. Aronson, Martha Kennedy Terris, Matthew R. Cooperberg, Christopher L. Amling, Stephen J. Freedland, Christopher J. Kane

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective: To analyze factors associated with metastases, prostate cancer-specific mortality, and all-cause mortality in pN1 patients. Materials and methods: We analyzed 3,642 radical prostatectomy patients within the Shared Equal Access Regional Cancer Hospital (SEARCH) database. Pathologic Gleason grade, number of lymph nodes (LN) removed, and first postoperative prostate-specific antigen (PSA) (<0.2 ng/ml or ≥0.2 ng/ml) were among covariates assessed. Cox regression was used to analyze the association between characteristics and survival outcomes. Kaplan-Meier was used to estimate survival in pN1 patients stratified by first postoperative PSA. Results: Of 3,642 patients, 124 (3.4%) had pN1. There were 71 (60%) patients with 1 positive LN, 32 (27%) with 2 positive LNs, and 15 (13%) with ≥3. Among men with pN1, first postoperative PSA was<0.2 ng/ml in 46 patients (51%) and ≥0.2 ng/ml in 44 patients (49%). Univariable Cox regression determined pathological Gleason grade (P = 0.021), seminal vesicle invasion (P = 0.010), and first postoperative PSA ≥0.2 ng/ml (P = 0.005) were associated with metastases. First postoperative PSA ≥0.2 ng/ml was associated with metastasis on multivariable analysis (P = 0.046). Log-rank analysis revealed a more favorable metastases-free survival in patients with a first postoperative PSA<0.2 ng/ml (P = 0.001). Estimated 5-year metastases-free survival rate was 99% for patients with a first postoperative PSA<0.2 ng/ml and 87% for ≥0.2 ng/ml. Conclusions: pN1 patients with a first postoperative PSA ≥0.2 ng/ml were more likely to develop metastases. First postoperative PSA may be useful in identifying pN1 patients who harbor distant disease and aid in secondary treatment decisions.

Original languageEnglish (US)
Pages (from-to)239.e17-239.e25
JournalUrologic Oncology: Seminars and Original Investigations
Volume36
Issue number5
DOIs
StatePublished - May 1 2018

Fingerprint

Cancer Care Facilities
Prostate-Specific Antigen
Prostatic Neoplasms
Databases
Neoplasm Metastasis
Survival
Lymph Nodes
Mortality
Seminal Vesicles
Prostatectomy
Statistical Factor Analysis
Survival Rate

Keywords

  • Lymph node
  • Metastases
  • PSA
  • Prostate neoplasms
  • Prostatectomy

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

First postoperative PSA is associated with outcomes in patients with node positive prostate cancer : Results from the SEARCH database. / McDonald, Michelle L.; Howard, Lauren E.; Aronson, William J.; Terris, Martha Kennedy; Cooperberg, Matthew R.; Amling, Christopher L.; Freedland, Stephen J.; Kane, Christopher J.

In: Urologic Oncology: Seminars and Original Investigations, Vol. 36, No. 5, 01.05.2018, p. 239.e17-239.e25.

Research output: Contribution to journalArticle

McDonald, Michelle L. ; Howard, Lauren E. ; Aronson, William J. ; Terris, Martha Kennedy ; Cooperberg, Matthew R. ; Amling, Christopher L. ; Freedland, Stephen J. ; Kane, Christopher J. / First postoperative PSA is associated with outcomes in patients with node positive prostate cancer : Results from the SEARCH database. In: Urologic Oncology: Seminars and Original Investigations. 2018 ; Vol. 36, No. 5. pp. 239.e17-239.e25.
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abstract = "Objective: To analyze factors associated with metastases, prostate cancer-specific mortality, and all-cause mortality in pN1 patients. Materials and methods: We analyzed 3,642 radical prostatectomy patients within the Shared Equal Access Regional Cancer Hospital (SEARCH) database. Pathologic Gleason grade, number of lymph nodes (LN) removed, and first postoperative prostate-specific antigen (PSA) (<0.2 ng/ml or ≥0.2 ng/ml) were among covariates assessed. Cox regression was used to analyze the association between characteristics and survival outcomes. Kaplan-Meier was used to estimate survival in pN1 patients stratified by first postoperative PSA. Results: Of 3,642 patients, 124 (3.4{\%}) had pN1. There were 71 (60{\%}) patients with 1 positive LN, 32 (27{\%}) with 2 positive LNs, and 15 (13{\%}) with ≥3. Among men with pN1, first postoperative PSA was<0.2 ng/ml in 46 patients (51{\%}) and ≥0.2 ng/ml in 44 patients (49{\%}). Univariable Cox regression determined pathological Gleason grade (P = 0.021), seminal vesicle invasion (P = 0.010), and first postoperative PSA ≥0.2 ng/ml (P = 0.005) were associated with metastases. First postoperative PSA ≥0.2 ng/ml was associated with metastasis on multivariable analysis (P = 0.046). Log-rank analysis revealed a more favorable metastases-free survival in patients with a first postoperative PSA<0.2 ng/ml (P = 0.001). Estimated 5-year metastases-free survival rate was 99{\%} for patients with a first postoperative PSA<0.2 ng/ml and 87{\%} for ≥0.2 ng/ml. Conclusions: pN1 patients with a first postoperative PSA ≥0.2 ng/ml were more likely to develop metastases. First postoperative PSA may be useful in identifying pN1 patients who harbor distant disease and aid in secondary treatment decisions.",
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T1 - First postoperative PSA is associated with outcomes in patients with node positive prostate cancer

T2 - Results from the SEARCH database

AU - McDonald, Michelle L.

AU - Howard, Lauren E.

AU - Aronson, William J.

AU - Terris, Martha Kennedy

AU - Cooperberg, Matthew R.

AU - Amling, Christopher L.

AU - Freedland, Stephen J.

AU - Kane, Christopher J.

PY - 2018/5/1

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N2 - Objective: To analyze factors associated with metastases, prostate cancer-specific mortality, and all-cause mortality in pN1 patients. Materials and methods: We analyzed 3,642 radical prostatectomy patients within the Shared Equal Access Regional Cancer Hospital (SEARCH) database. Pathologic Gleason grade, number of lymph nodes (LN) removed, and first postoperative prostate-specific antigen (PSA) (<0.2 ng/ml or ≥0.2 ng/ml) were among covariates assessed. Cox regression was used to analyze the association between characteristics and survival outcomes. Kaplan-Meier was used to estimate survival in pN1 patients stratified by first postoperative PSA. Results: Of 3,642 patients, 124 (3.4%) had pN1. There were 71 (60%) patients with 1 positive LN, 32 (27%) with 2 positive LNs, and 15 (13%) with ≥3. Among men with pN1, first postoperative PSA was<0.2 ng/ml in 46 patients (51%) and ≥0.2 ng/ml in 44 patients (49%). Univariable Cox regression determined pathological Gleason grade (P = 0.021), seminal vesicle invasion (P = 0.010), and first postoperative PSA ≥0.2 ng/ml (P = 0.005) were associated with metastases. First postoperative PSA ≥0.2 ng/ml was associated with metastasis on multivariable analysis (P = 0.046). Log-rank analysis revealed a more favorable metastases-free survival in patients with a first postoperative PSA<0.2 ng/ml (P = 0.001). Estimated 5-year metastases-free survival rate was 99% for patients with a first postoperative PSA<0.2 ng/ml and 87% for ≥0.2 ng/ml. Conclusions: pN1 patients with a first postoperative PSA ≥0.2 ng/ml were more likely to develop metastases. First postoperative PSA may be useful in identifying pN1 patients who harbor distant disease and aid in secondary treatment decisions.

AB - Objective: To analyze factors associated with metastases, prostate cancer-specific mortality, and all-cause mortality in pN1 patients. Materials and methods: We analyzed 3,642 radical prostatectomy patients within the Shared Equal Access Regional Cancer Hospital (SEARCH) database. Pathologic Gleason grade, number of lymph nodes (LN) removed, and first postoperative prostate-specific antigen (PSA) (<0.2 ng/ml or ≥0.2 ng/ml) were among covariates assessed. Cox regression was used to analyze the association between characteristics and survival outcomes. Kaplan-Meier was used to estimate survival in pN1 patients stratified by first postoperative PSA. Results: Of 3,642 patients, 124 (3.4%) had pN1. There were 71 (60%) patients with 1 positive LN, 32 (27%) with 2 positive LNs, and 15 (13%) with ≥3. Among men with pN1, first postoperative PSA was<0.2 ng/ml in 46 patients (51%) and ≥0.2 ng/ml in 44 patients (49%). Univariable Cox regression determined pathological Gleason grade (P = 0.021), seminal vesicle invasion (P = 0.010), and first postoperative PSA ≥0.2 ng/ml (P = 0.005) were associated with metastases. First postoperative PSA ≥0.2 ng/ml was associated with metastasis on multivariable analysis (P = 0.046). Log-rank analysis revealed a more favorable metastases-free survival in patients with a first postoperative PSA<0.2 ng/ml (P = 0.001). Estimated 5-year metastases-free survival rate was 99% for patients with a first postoperative PSA<0.2 ng/ml and 87% for ≥0.2 ng/ml. Conclusions: pN1 patients with a first postoperative PSA ≥0.2 ng/ml were more likely to develop metastases. First postoperative PSA may be useful in identifying pN1 patients who harbor distant disease and aid in secondary treatment decisions.

KW - Lymph node

KW - Metastases

KW - PSA

KW - Prostate neoplasms

KW - Prostatectomy

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