Evaluation of Risk Groups for the Prediction of Biochemical Progression in Patients Undergoing Radical Prostatectomy

Abstract

According to previous studies, preoperative and postoperative prostate specific antigen level measurements, pathological stage, Gleason score, extraprostatic extension, positive surgical margins and seminal vesicle invasion could be the predictors of biochemical progression and biochemical progression-free survival in prostate cancer patients undergoing radical prostatectomy. In our study, we showed that postoperative prostate specific antigen level higher than ≥0.2 ng/dL is the most important predictor of biochemical progression and biochemical progression-free survival in prostate cancer patients undergoing radical prostatectomy. Abstract Objective: The aim of this study was to investigate the potential relationship between biochemical progression and prognostic risk factors in patients with prostate cancer (PCa) patients undergoing radical prostatectomy (RP). Materials and Methods: After inclusion/exclusion criteria were applied, 216 patients who underwent RP were included in this study. Follow-up protocol included prostate specific antigen (PSA) measurements; every 3 months for the first year, every 6 months for the second year, and an annual check after 2 years. Preoperative and postoperative PSA measurements, pathological stage, Gleason score (GS), extraprostatic extension, positive surgical margins and seminal vesicle invasion were evaluated. Uni- and multivariable analyses were used to detect the relationship between biochemical progression, biochemical progression-free survival (BPFS) and prognostic risk factors. Results: Median follow-up was 29 months. Biochemical progression was observed in 39 (18.1%) patients, in 18 (9.7%) of 185 patients with first postoperative PSA level of <0.2 ng/dL, and 21 (67.7%) of 31 patients with first postoperative PSA level of ≥0.2 ng/dL. Patients with first postoperative PSA level of ≥0.2 ng/dL had a statistically significant higher risk of biochemical progression and shorter BPFS (odds ratio: 2.41; 95% confidence interval: 1.84-3.10; p<0.001), in univariate and multivariate analyses. Patients with GS ≥8 or T3-4 or positive surgical margins had a statistically significant higher risk of biochemical progression (p<0.001, p=0.003, p<0.001). Conclusion: Postoperative PSA level higher than ≥0.2 ng/dL was the most important predictor of biochemical progression and BPFS after RP. GS ≥8, T3-4 stages, and positive surgical margins are also related to biochemical progression.