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The Importance of immediate prostate specific antigen value after radical prostatectomy on prediction of clinical progression in lymph node positive patients
Date Issued |
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2018-05-25 |
ISSN 1569-9056 (Linking).
Introduction & Objectives: To evaluate the prognostic value of immediate prostate specific antigen (PSA) level on clinical progression (CP) in lymph nodes positive patients who underwent radical prostatectomy (RP). Materials & Methods: The study included 78 men with lymph nodes invasion (LNI) who underwent RP and lymph nodes dissection at a single institution between 2002 and 2017. All study patients had complete preoperative, pathological and post-operative follow-up data including PSA value at first two months after RP. All men, according initial postoperative PSA at first 8 weeks after RP, were divided into two groups: complete biochemical response (PSA <0.2 ng/ml) vs. PSA persistence (PSA ≥0.2 ng/ml). Fisher’s exact and Whitney-Mann tests were used to compare difference of various parameters according early postoperative PSA. Kaplan-Meier curves and log-rank analysis were done to compare 5 and 10-years clinical progression free survival (CPFS) rates according early postoperative PSA. Cox regression analysis was used to test the impact of first PSA value and other covariates – pathological Gleason score (GS), surgical margins status (R0 vs. R1), number of positive lymph nodes (1-2 vs. ≥3) and type of additional therapy (adjuvant vs. salvage). Results: Overall the median (interquartiles) follow-up was 41.5 (24.5-73) months, median patients age was 65 (57-68) years, median preoperative PSA was 13.2 (8.4-20) ng/ml, median number of lymph nodes removed was 10 (7-16), median number of positive nodes was 2 (1-3). Overall CP was detected in 22 (28.2%) cases with significantly higher rate in PSA persistence group (38.3 vs. 12.9%, p=0.02). Overall 5 and 10-year CPFS was 66.9 and 58.4%, respectively. Cox regression analysis confirmed that early PSA value (≥0.2 vs.<0.2 ng/ml) was significant predictor of CP – HR 3.9, 95%CI (1.30 – 11.49), p=0.015. Thirty-one men (39.7%) had complete PSA response at first[...].