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Comparison of oncologic outcomes after radical prostatectomy in men diagnosed with prostate cancer with PSA levels below and above 4 ng/mL

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Abstract

Purpose

To assess whether the PSA level (threshold 4 ng/mL) is a prognostic factor in biochemical recurrence-free survival in men with prostate cancer (PCa) with an initial PSA level <10 ng/mL who underwent robotic-assisted laparoscopic radical prostatectomy (RARLP).

Methods

We prospectively recruited data for consecutive patients treated by RARLP for PCa with an initial PSA level below 10 ng/mL between 2003 and 2011 at our institution. We divided the population into two groups: patients with a PSA level below 4 ng/mL (G1; n = 53) and patients with a PSA level between 4 and 10 ng/mL (G2; n = 371). Biochemical recurrence was defined as a single increase in PSA greater than 0.2 ng/mL after surgery. Multivariate analysis was used to assess prognostic factors of recurrence-free survival.

Results

Overall, 424 patients were included, and the median age was 62 (58–67) years. The median PSA was 5.8 ng/mL (4.8–7.7 ng/mL). Overall, 6 patients from G1 and 34 patients from G2 experienced a biochemical recurrence. Overall, the 5-year recurrence-free survival rate was 86.6 %. The PSA level at diagnosis (under or over 4 ng/mL) was not significantly linked to recurrence-free survival (HR = 0.59, p = 0.25). However, positive margins and a Gleason score >7 on the specimen were significantly linked to recurrence-free survival with respective hazard ratios of 4.30 (p < 0.0001) and 6.18 (p < 0.0001), respectively.

Conclusion

A PSA level <4 ng/mL alone appears to be obsolete as a cut-off to define a population of men likely to have indolent disease.

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Conflict of interest

The authors state that they have no conflicts of interest to disclose regarding the current manuscript.

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Authors and Affiliations

  1. Academic Department of Urology, Pitié-Salpétrière hospital (Assistance Publique—Hôpitaux de Paris), 83, Boulevard de l’hôpital, 75013, Paris, France

    Charles Dariane, Sarah J. Drouin, Benoit Wolff, Pierre Mozer, Marc-Olivier Bitker & Morgan Rouprêt

  2. Academic Biostatistics Department, Pitié-Salpétrière hospital (Assistance Publique—Hôpitaux de Paris), 83, Boulevard de l’hôpital, 75013, Paris, France

    Chloé Le Cossec & Benjamin Granger

  3. Institut Universitaire de Cancérologie, GRC5, ONCOTYPE-Uro, Université Paris 6, Paris, France

    Marc-Olivier Bitker, Olivier Cussenot & Morgan Rouprêt

  4. Academic Department of Urology, Vienna University, Vienna, Austria

    Shahrokh F. Shariat

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  1. Charles Dariane
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  2. Chloé Le Cossec
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Correspondence to Morgan Rouprêt.

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Dariane, C., Le Cossec, C., Drouin, S.J. et al. Comparison of oncologic outcomes after radical prostatectomy in men diagnosed with prostate cancer with PSA levels below and above 4 ng/mL. World J Urol 32, 481–487 (2014). https://doi.org/10.1007/s00345-013-1089-0

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  • DOI: https://doi.org/10.1007/s00345-013-1089-0

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