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The role of free to total PSA ratio in prediction of extracapsular tumor extension and biochemical recurrence after radical prostatectomy in patients with PSA between 4 and 10 ng/ml

  • Urology – Original Paper
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Abstract

Objectives

The prognostic value of free to total PSA ratio (F/T PSA) in patients eligible for radical prostatectomy (RP) is controversial. The aim of the present study was to evaluate correlation of F/T PSA with tumor extracapsular extension (ECE) and biochemical recurrence (BR) at long-term follow-up.

Patient and methods

Clinical and pathological data were prospectively gathered from 200 patients treated with RP for clinically localized prostate cancer (PCa) and PSA between 4 and 10 ng/mL. Correlations of preoperative variables including F/T PSA with ECE and BR were evaluated with uni- and multivariate analysis. Adjunctive analyses evaluated the association of PSA F/T with other pathological results. The relationship between preoperative F/T PSA and BR was also assessed with Kaplan–Meier survival analysis.

Results

Lower F/T PSA was significantly correlated with ECE (p = 0.0063), higher GS (p = 0.0054), and seminal vesicles involvement (p = 0.0047). The F/T PSA value of 14% provided the greatest discrimination in predicting ECE. At multivariate analysis, F/T PSA did not achieve the statistical significance for predicting ECE independently. At a mean (median, range) follow-up of 52 (48, 14–116) months, preoperative F/T PSA resulted significantly correlated with BR (p = 0.001). At the Kaplan–Meier survival analysis, the 5-year BR free survival rate resulted 89.3 and 68.9% in the group with F/T PSA >14 and ≤14 ng/mL, respectively (log rank p = 0.0022). At Cox proportional hazard model, only ECE resulted an independent predictor of BR (R = 2.646, p = 0.037).

Conclusion

In patients with clinically localized PCa and PSA 4–10 ng/ml, lower F/T PSA was significantly associated with ECE, other adverse pathologic features, and with BR at the long-term follow-up, but only ECE resulted an independent predictor of BR in our series.

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Authors and Affiliations

  1. Department of Urology, University of Florence, Careggi Hospital, Florence, Italy

    Lorenzo Masieri, Andrea Minervini, Gianni Vittori, Michele Lanciotti, Federico Lanzi, Alberto Lapini, Marco Carini & Sergio Serni

  2. Clinica Urologica I, Azienda Ospedaliera Careggi, Università di Firenze, Villa Monna Tessa, Viale Pieraccini 18, 50139, Florence, Italy

    Lorenzo Masieri & Michele Lanciotti

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  1. Lorenzo Masieri
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  2. Andrea Minervini
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  3. Gianni Vittori
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  4. Michele Lanciotti
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  5. Federico Lanzi
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  6. Alberto Lapini
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  7. Marco Carini
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  8. Sergio Serni
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Correspondence to Lorenzo Masieri or Michele Lanciotti.

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Masieri, L., Minervini, A., Vittori, G. et al. The role of free to total PSA ratio in prediction of extracapsular tumor extension and biochemical recurrence after radical prostatectomy in patients with PSA between 4 and 10 ng/ml. Int Urol Nephrol 44, 1031–1038 (2012). https://doi.org/10.1007/s11255-012-0135-y

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  • DOI: https://doi.org/10.1007/s11255-012-0135-y

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