Prognostic significance of a novel indicator (PSA(postd3)/PSA(pre)) for PSA recurrence in patients after radical prostatectomy

PURPOSE: Radical prostatectomy (RP) is a common treatment for prostate cancer, but a fraction of patients may experience PSA recurrence after surgery, manifesting as an elevation in prostate specific antigen (PSA). Vast literature has reported different prognostic factors for PSA recurrence without reaching a consensus. This retrospective study investigated the efficacy of a new indicator in predicting PSA recurrence in patients after RP. PATIENTS AND METHODS: From October 2000 to December 2015, 102 PCa patients who underwent laparoscopic prostatectomy in the Urology Department of Peking Union Medical College Hospital were analyzed. We calculated PSA(postd3)/PSA(pre), defined as the ratio of the PSA on day 3 postop as the numerator and the pre-operative PSA as the denominator, in these patients to represent PSA decrement after surgery, and investigated its relationship with PSA recurrence during follow-up. RESULTS: The receiver operating characteristic (ROC) curve of PSA(postd3)/PSA(pre) derived a cut-off at 0.453 (sensitivity=0.704, specificity=0.853, P<0.0001), suggesting an increased risk of PSA recurrence in patients whose PSA on day 3 postop did not decrease to approximately half of their preoperative levels. Among several factors, PSA(postd3)/PSA(pre) (P<0.0001), pathological T stage (P=0.042) and Gleason Grade (P=0.021) were determined to be significantly associated with PSA recurrence by Fisher’s exact test, while only PSA(postd3)/PSA(pre) (P<0.001) was significantly related to PSA recurrence-free survival (PRFS) by multivariate logistic regression analysis. CONCLUSION: These results imply that PSA(postd3)/PSA(pre) could provide substantial information for PSA recurrence prediction in patients after RP.