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Predictive factors and the important role of detectable prostate-specific antigen for detection of clinical recurrence and cancer-specific mortality following robot-assisted radical prostatectomy

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Abstract

Purpose

To evaluate predictive factors associated with detectable prostate-specific antigen (PSA) and describe clinical recurrence (CR) and cancer-specific mortality (CSM) after robot-assisted radical prostatectomy (RARP).

Methods

The study included 2500 patients who were treated with RARP at a single institution between 2000 and 2016. All patients had clinically localized PCa. Patients were divided into two groups according to PSA value at 6 weeks after surgery: undetectable (n = 2271; PSA < 0.1 ng/dl) and persistently elevated (n = 229; PSA ≥ 0.1 ng/dl). The association between various covariates and: (1) detectable PSA and (2) CR was evaluated. Kaplan–Meier analyses estimated CR and CSM rates according to PSA persistence.

Results

Inside the group of detectable PSA, 146 men (63.75%) received adjuvant treatments, 44 patients (19.21%) salvages therapies and 38 men (16.5%) experienced CR. Factors associated with aggressive disease predicted PSA persistence. Within patients with detectable PSA, pathologic stage ≥ pT3a (HR 2.71; p < 0.029) and to received adjuvant androgen deprivation therapy (ADT) due to bad prognosis tumors (HR 13.36; p < 0.001) were associated with CR. Overall 14 (0.56%) died of PCa. 5 and 10-year CSM rates were higher for patients with CR (9.6 and 23.7%, p < 0.001), and Gleason ≥ 8 (5.7 and 6.9%, p = 0.003).

Conclusions

A detectable PSA is affected by factors associated with aggressive prostate cancer. Within men with persistent PSA, those with higher pathologic stage and who received adjuvant ADT are more likely to have CR. Patients with CR, Gleason ≥ 8, and those who received adjuvant ADT must have a close monitoring due to the high rate of mortality.

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Authors and Affiliations

  1. Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, 42, Bd Jourdan, 75014, Paris Cedex 14, France

    S. García-Barreras, F. Rozet, I. Nunes-Silva, V. Srougi, R. Sanchez-Salas, E. Barret, M. Galiano & X. Cathelineau

Authors
  1. S. García-Barreras
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  2. F. Rozet
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  3. I. Nunes-Silva
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  4. V. Srougi
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  5. R. Sanchez-Salas
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  6. E. Barret
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  7. M. Galiano
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  8. X. Cathelineau
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Contributions

SG-B: project development, data collection and manuscript writing. FR: project development. IN-S: statistical analysis. VS: data collection. RS-S: data collection. EB: editing. MG: editing. XC: project development and manuscript writing.

Corresponding author

Correspondence to S. García-Barreras.

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Conflict of interest

The authors declare no conflict of interest.

Ethical approval

CEPAR: Comité d’Evaluation des Protocoles et d’Aide à la Recherche (Protocol Evaluation Committee and for Research Assistance) committee approved the study.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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García-Barreras, S., Rozet, F., Nunes-Silva, I. et al. Predictive factors and the important role of detectable prostate-specific antigen for detection of clinical recurrence and cancer-specific mortality following robot-assisted radical prostatectomy. Clin Transl Oncol 20, 1004–1010 (2018). https://doi.org/10.1007/s12094-017-1812-1

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  • DOI: https://doi.org/10.1007/s12094-017-1812-1

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