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

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.