Impact of persistent PSA after salvage radical prostatectomy: a multicenter study

Area of Science:

• Urology
• Oncology
• Surgical Oncology

Background:

• Persistent prostate-specific antigen (PSA) after radical prostatectomy (RP) is linked to recurrence.
• The impact of persistent PSA on outcomes after salvage RP remains unclear.

Purpose of the Study:

• To evaluate the association between persistent PSA after salvage RP and long-term oncologic outcomes.
• To determine if persistent PSA is an independent predictor of recurrence, metastasis, and mortality post-salvage RP.

Main Methods:

• Retrospective analysis of 580 patients undergoing salvage RP across 12 centers (2000-2021).
• Persistent PSA defined as PSA ≥ 0.1 ng/mL at first measurement post-salvage RP.
• Kaplan-Meier and multivariable Cox regression analyses assessed outcomes (biochemical recurrence, metastasis, death).

Main Results:

• 42% of patients had persistent PSA post-salvage RP.
• Persistent PSA was associated with significantly lower BCR-free (6.6% vs. 59%), metastasis-free (71% vs. 88%), and overall survival (77% vs. 94%) at 84 months.
• Persistent PSA independently predicted biochemical recurrence (HR: 5.47) and death (HR: 3.07).

Conclusions:

• Persistent PSA is a frequent finding after salvage RP.
• Persistent PSA is a significant independent predictor of adverse oncologic outcomes, including recurrence and mortality.
• Intensified post-operative surveillance is recommended for salvage RP patients to detect persistent PSA.