TY - JOUR
T1 - Pre-operative percent free psa predicts clinical outcomes in patients treated with radical prostatectomy with total PSA levels below 10 ng/ml
AU - Shariat, Shahrokh F.
AU - Abdel-Aziz, Khaled F.
AU - Roehrborn, Claus
AU - Lotan, Yair
N1 - Funding Information:
SFS is supported by the Austrian Program for Advanced Research and Technology.
Copyright:
Copyright 2008 Elsevier B.V., All rights reserved.
PY - 2006/2
Y1 - 2006/2
N2 - Introduction: To evaluate the association of total prostate specific antigen (T-PSA) and percent free PSA (%F-PSA) with prostate cancer outcomes in patients treated with radical prostatectomy (RP). Methods: Pre-operative serum levels of T-PSA and F-PSA were prospectively measured in 402 consecutive patients treated with RP for clinically localized prostate cancer who had T-PSA levels below 10 ng/ml. Results: T-PSA was not associated with any prostate cancer characteristics or outcomes. Lower %F-PSA was significantly associated with higher percent positive biopsy cores, extracapsular extension, seminal vesicle involvement, lympho-vascular invasion, perineural invasion, positive surgical margins, and higher pathologic Gleason sum. When adjusted for the effects of standard pre-operative features, lower %F-PSA significantly predicted non-organ confined disease, seminal vesicle involvement, lympho-vascular invasion, and biochemical progression. %F-PSA did not retain its association with biochemical progression after adjusting for the effects of standard post-operative features. Based on data from 22 patients with biochemical progression, lower %F-PSA was correlated with shorter T-PSA doubling time after biochemical progression (rho = 0.681, p = 0.010). %F-PSA was lower in patients who failed salvage radiation therapy (p = 0.031) and in patients who developed distant cancer metastases compared to patients who did not (p < 0.001). Conclusions: Pre-operative T-PSA is not associated with prostate cancer outcomes after RP when levels are below 10 ng/ml. In contrast, pre-operative %F-PSA is associated with adverse pathologic features, biochemical progression, and features of aggressive disease progression in patients treated with RP and T-PSA levels below 10 ng/ml. %F-PSA may improve pre-operative predictive models for predicting clinical outcomes of patients diagnosed with prostate cancer nowadays.
AB - Introduction: To evaluate the association of total prostate specific antigen (T-PSA) and percent free PSA (%F-PSA) with prostate cancer outcomes in patients treated with radical prostatectomy (RP). Methods: Pre-operative serum levels of T-PSA and F-PSA were prospectively measured in 402 consecutive patients treated with RP for clinically localized prostate cancer who had T-PSA levels below 10 ng/ml. Results: T-PSA was not associated with any prostate cancer characteristics or outcomes. Lower %F-PSA was significantly associated with higher percent positive biopsy cores, extracapsular extension, seminal vesicle involvement, lympho-vascular invasion, perineural invasion, positive surgical margins, and higher pathologic Gleason sum. When adjusted for the effects of standard pre-operative features, lower %F-PSA significantly predicted non-organ confined disease, seminal vesicle involvement, lympho-vascular invasion, and biochemical progression. %F-PSA did not retain its association with biochemical progression after adjusting for the effects of standard post-operative features. Based on data from 22 patients with biochemical progression, lower %F-PSA was correlated with shorter T-PSA doubling time after biochemical progression (rho = 0.681, p = 0.010). %F-PSA was lower in patients who failed salvage radiation therapy (p = 0.031) and in patients who developed distant cancer metastases compared to patients who did not (p < 0.001). Conclusions: Pre-operative T-PSA is not associated with prostate cancer outcomes after RP when levels are below 10 ng/ml. In contrast, pre-operative %F-PSA is associated with adverse pathologic features, biochemical progression, and features of aggressive disease progression in patients treated with RP and T-PSA levels below 10 ng/ml. %F-PSA may improve pre-operative predictive models for predicting clinical outcomes of patients diagnosed with prostate cancer nowadays.
KW - Metastasis
KW - Percent free prostate-specific antigen
KW - Progression
KW - Prostatic neoplasms
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U2 - 10.1016/j.eururo.2005.10.027
DO - 10.1016/j.eururo.2005.10.027
M3 - Article
C2 - 16387412
AN - SCOPUS:32044437615
SN - 0302-2838
VL - 49
SP - 293
EP - 302
JO - European urology
JF - European urology
IS - 2
ER -