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Persistent Prostate-Specific Antigen After Radical Prostatectomy and Its Impact on Oncologic Outcomes.

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Persistent prostate-specific antigen (PSA) after radical prostatectomy indicates a higher risk of cancer recurrence and death. Early salvage radiotherapy may improve survival outcomes for selected patients with persistent PSA.

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Area of Science:

  • Urology
  • Oncology
  • Medical Research

Background:

  • Persistent prostate-specific antigen (PSA) after radical prostatectomy (RP) is a significant indicator of poor prognosis.
  • Early detection of persistent PSA is crucial for predicting long-term oncologic outcomes.

Purpose of the Study:

  • To evaluate the impact of persistent PSA at 6 weeks post-RP on long-term oncologic outcomes.
  • To identify patient characteristics associated with persistent PSA after RP.
  • To assess the effectiveness of salvage radiotherapy (SRT) in patients with persistent PSA.

Main Methods:

  • Retrospective analysis of a high-volume center database including 11,604 patients.
  • Patients were categorized based on persistent (≥0.1 ng/ml) versus undetectable (<0.1 ng/ml) PSA at 6 weeks post-RP.
  • Logistic regression, Kaplan-Meier, Cox regression, and propensity score matching (PSM) were used for analysis.

Main Results:

  • 8.8% of patients had persistent PSA post-RP.
  • Persistent PSA was significantly associated with worse metastasis-free survival (MFS), overall survival (OS), and cancer-specific survival (CSS) at 15 years.
  • Persistent PSA independently predicted metastasis, death, and cancer-specific death (HRs ranging from 1.86 to 3.59).
  • SRT demonstrated improved OS and CSS in patients with persistent PSA after PSM.

Conclusions:

  • Persistent PSA following radical prostatectomy is a strong predictor of adverse oncologic outcomes, including metastasis and mortality.
  • Salvage radiotherapy may offer a survival benefit for carefully selected patients with persistent PSA.