Natural History of Persistently Elevated Prostate Specific Antigen After Radical Prostatectomy: Results From the SEARCH Database

Daniel M. Moreira, Joseph C. Presti, William J. Aronson, Martha Kennedy Terris, Christopher J. Kane, Christopher L. Amling, Stephen J. Freedland

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Purpose: We examined natural history, predictors of biochemical recurrence and all cause mortality in patients with persistently elevated prostate specific antigen after radical prostatectomy in the Shared Equal Access Regional Cancer Hospital cohort. Materials and Methods: We reviewed data on 1,156 men treated with radical prostatectomy after 1997. Prostate specific antigen persistence was defined as failure to achieve prostate specific antigen less than 0.03 ng/ml within 6 months postoperatively. Disease-free and overall survival was compared between men with and without persistence using the log rank test. Predictors of biochemical recurrence and all cause death were analyzed using the Cox model. Results: A total of 291 men (25%) had persistence, which was associated with increased biochemical recurrence and all cause death (p <0.001 and 0.041, respectively). In patients with persistence 1 and 5-year biochemical recurrence-free survival was 68% and 36%, significantly lower than 95% and 72%, respectively, in men without persistence. Ten-year overall survival in patients with vs without persistence was 63% vs 80%. In men with persistence independent predictors of prostate specific antigen recurrence were higher prostate specific antigen nadir (HR 2.19, p <0.001), positive surgical margins (HR 1.75, p = 0.022) and high pathological Gleason score (8-10 vs 2-6 HR 2.40, p = 0.026). Independent predictors of overall mortality were a higher prostate specific antigen nadir (HR 1.46, p = 0.013) and seminal vesicle invasion (HR 3.15, p = 0.047). Conclusions: Prostate specific antigen persistence is associated with increased biochemical recurrence and overall mortality. In men with persistence the prostate specific antigen nadir is an independent predictor of recurrence and mortality. Thus, prostate specific antigen persistence and nadir are important tools for early postoperative risk stratification.

Original languageEnglish (US)
Pages (from-to)2250-2256
Number of pages7
JournalJournal of Urology
Volume182
Issue number5
DOIs
StatePublished - Nov 1 2009
Externally publishedYes

Fingerprint

Prostate-Specific Antigen
Prostatectomy
Natural History
Databases
Recurrence
Mortality
Cause of Death
Cancer Care Facilities
Survival
Neoplasm Grading
Seminal Vesicles
Proportional Hazards Models
Disease-Free Survival

Keywords

  • mortality
  • prostate
  • prostate-specific antigen
  • prostatectomy
  • prostatic neoplasms

ASJC Scopus subject areas

  • Urology

Cite this

Natural History of Persistently Elevated Prostate Specific Antigen After Radical Prostatectomy : Results From the SEARCH Database. / Moreira, Daniel M.; Presti, Joseph C.; Aronson, William J.; Terris, Martha Kennedy; Kane, Christopher J.; Amling, Christopher L.; Freedland, Stephen J.

In: Journal of Urology, Vol. 182, No. 5, 01.11.2009, p. 2250-2256.

Research output: Contribution to journalArticle

Moreira, Daniel M. ; Presti, Joseph C. ; Aronson, William J. ; Terris, Martha Kennedy ; Kane, Christopher J. ; Amling, Christopher L. ; Freedland, Stephen J. / Natural History of Persistently Elevated Prostate Specific Antigen After Radical Prostatectomy : Results From the SEARCH Database. In: Journal of Urology. 2009 ; Vol. 182, No. 5. pp. 2250-2256.
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abstract = "Purpose: We examined natural history, predictors of biochemical recurrence and all cause mortality in patients with persistently elevated prostate specific antigen after radical prostatectomy in the Shared Equal Access Regional Cancer Hospital cohort. Materials and Methods: We reviewed data on 1,156 men treated with radical prostatectomy after 1997. Prostate specific antigen persistence was defined as failure to achieve prostate specific antigen less than 0.03 ng/ml within 6 months postoperatively. Disease-free and overall survival was compared between men with and without persistence using the log rank test. Predictors of biochemical recurrence and all cause death were analyzed using the Cox model. Results: A total of 291 men (25{\%}) had persistence, which was associated with increased biochemical recurrence and all cause death (p <0.001 and 0.041, respectively). In patients with persistence 1 and 5-year biochemical recurrence-free survival was 68{\%} and 36{\%}, significantly lower than 95{\%} and 72{\%}, respectively, in men without persistence. Ten-year overall survival in patients with vs without persistence was 63{\%} vs 80{\%}. In men with persistence independent predictors of prostate specific antigen recurrence were higher prostate specific antigen nadir (HR 2.19, p <0.001), positive surgical margins (HR 1.75, p = 0.022) and high pathological Gleason score (8-10 vs 2-6 HR 2.40, p = 0.026). Independent predictors of overall mortality were a higher prostate specific antigen nadir (HR 1.46, p = 0.013) and seminal vesicle invasion (HR 3.15, p = 0.047). Conclusions: Prostate specific antigen persistence is associated with increased biochemical recurrence and overall mortality. In men with persistence the prostate specific antigen nadir is an independent predictor of recurrence and mortality. Thus, prostate specific antigen persistence and nadir are important tools for early postoperative risk stratification.",
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AB - Purpose: We examined natural history, predictors of biochemical recurrence and all cause mortality in patients with persistently elevated prostate specific antigen after radical prostatectomy in the Shared Equal Access Regional Cancer Hospital cohort. Materials and Methods: We reviewed data on 1,156 men treated with radical prostatectomy after 1997. Prostate specific antigen persistence was defined as failure to achieve prostate specific antigen less than 0.03 ng/ml within 6 months postoperatively. Disease-free and overall survival was compared between men with and without persistence using the log rank test. Predictors of biochemical recurrence and all cause death were analyzed using the Cox model. Results: A total of 291 men (25%) had persistence, which was associated with increased biochemical recurrence and all cause death (p <0.001 and 0.041, respectively). In patients with persistence 1 and 5-year biochemical recurrence-free survival was 68% and 36%, significantly lower than 95% and 72%, respectively, in men without persistence. Ten-year overall survival in patients with vs without persistence was 63% vs 80%. In men with persistence independent predictors of prostate specific antigen recurrence were higher prostate specific antigen nadir (HR 2.19, p <0.001), positive surgical margins (HR 1.75, p = 0.022) and high pathological Gleason score (8-10 vs 2-6 HR 2.40, p = 0.026). Independent predictors of overall mortality were a higher prostate specific antigen nadir (HR 1.46, p = 0.013) and seminal vesicle invasion (HR 3.15, p = 0.047). Conclusions: Prostate specific antigen persistence is associated with increased biochemical recurrence and overall mortality. In men with persistence the prostate specific antigen nadir is an independent predictor of recurrence and mortality. Thus, prostate specific antigen persistence and nadir are important tools for early postoperative risk stratification.

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