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• W2014408086 abstract "No AccessJournal of UrologyAdult urology1 Aug 2006Pathological Outcomes and Biochemical Progression in Men With T1c Prostate Cancer Undergoing Radical Prostatectomy With Prostate Specific Antigen 2.6 to 4.0 vs 4.1 to 6.0 ng/mlis accompanied byRadical Prostatectomy—Which Patients Benefit Most From Surgery? Danil V. Makarov, Elizabeth B. Humphreys, Leslie A. Mangold, Patrick C. Walsh, Alan W. Partin, Jonathan I. Epstein, and Stephen J. Freedland Danil V. MakarovDanil V. Makarov More articles by this author , Elizabeth B. HumphreysElizabeth B. Humphreys More articles by this author , Leslie A. MangoldLeslie A. Mangold More articles by this author , Patrick C. WalshPatrick C. Walsh More articles by this author , Alan W. PartinAlan W. Partin More articles by this author , Jonathan I. EpsteinJonathan I. Epstein More articles by this author , and Stephen J. FreedlandStephen J. Freedland More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2006.03.058AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Recent studies have suggested that the cut point for recommending prostate biopsy among men with a normal digital rectal examination should be greater than 2.5 ng/ml as opposed to the more traditional greater than 4.0 ng/ml. We compared outcomes between men with clinical stage T1c disease undergoing radical prostatectomy who had a low vs slightly increased prostate specific antigen. Materials and Methods: The study population consisted of 2,896 men treated with radical prostatectomy between 1985 and 2004 at a tertiary care referral center with clinical stage T1c disease and a pre-biopsy prostate specific antigen between 2.6 and 6.0 ng/ml. Using multivariate analysis we evaluated the association between pre-biopsy prostate specific antigen 2.6 to 4.0 ng/ml (784) vs 4.1 to 6.0 ng/ml (2,112), and pathological outcomes and biochemical progression. Results: After adjusting for multiple clinical and pathological characteristics, lower preoperative serum prostate specific antigen values were associated with decreased odds of Gleason score 7 or greater in the surgical specimen (p = 0.004), positive surgical margins (p = 0.02) and extraprostatic extension (p = 0.001). There was no significant association between these preoperative prostate specific antigen groups and odds of seminal vesicle invasion (p = 0.47) or lymph node metastasis (p = 0.90). Among the 1,534 men with followup information available there was a trend for increased risk of biochemical progression associated with a higher preoperative prostate specific antigen, although this trend did not reach statistical significance (relative risk 1.48, 95% CI 0.69–3.19, p = 0.31). Conclusions: In the current study of men with clinical stage T1c treated with radical prostatectomy a lower preoperative prostate specific antigen was associated with significantly more favorable pathological findings. Whether this degree of improved outcomes justifies the limitations associated with decreasing the prostate specific antigen cut point (eg increased biopsies performed and diagnosis of insignificant cancers) remains to be determined. References 1 : Operating characteristics of prostate-specific antigen in men with an initial PSA level of 3.0 ng/ml or lower. JAMA2005; 294: 66. 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Google Scholar 8 : Prostate cancers in men with low PSA levels–must we find them?. N Engl J Med2004; 350: 2292. Google Scholar 9 : Impact of preoperative serum PSA level from 0 to 10 ng/ml on pathological findings and disease-free survival after radical prostatectomy. Prostate2001; 48: 136. Google Scholar 10 : Age and PSA predict likelihood of organ-confined disease in men presenting with PSA less than 10 ng/mL: implications for screening. Urology2003; 62: 70. Google Scholar 11 : Screening with low PSA cutoff values results in low rates of positive surgical margins in radical prostatectomy specimens. Prostate2002; 53: 241. Google Scholar 12 : Cancer surveillance series: interpreting trends in prostate cancer–part I: Evidence of the effects of screening in recent prostate cancer incidence, mortality, and survival rates. J Natl Cancer Inst1999; 91: 1017. Google Scholar 13 : Prevalence of prostate cancer among men with a prostate-specific antigen level < or =4.0 ng per milliliter. N Engl J Med2004; 350: 2239. Google Scholar 14 : Prostate-specific antigen levels in the United States: implications of various definitions for abnormal. J Natl Cancer Inst2005; 97: 1132. Google Scholar 15 : Preoperative serum prostate specific antigen levels between 2 and 22 ng. /ml. correlate poorly with post-radical prostatectomy cancer morphology: prostate specific antigen cure rates appear constant between 2 and 9 ng./ml. J Urol2002; 167: 103. Link, Google Scholar 16 : Lower prostate specific antigen outcome than expected following radical prostatectomy in patients with high grade prostate and a prostatic specific antigen level of 4 ng/ml. or less. J Urol2002; 167: 2025. Link, Google Scholar 17 : Early detection of prostate cancer with low PSA cut-off values leads to significant stage migration in radical prostatectomy specimens. Prostate2003; 57: 93. Google Scholar 18 : Biochemical outcome after radical prostatectomy among men with normal preoperative serum prostate-specific antigen levels. Cancer2004; 101: 748. Google Scholar 19 : Natural history of progression after PSA elevation following radical prostatectomy. JAMA1999; 281: 1591. Google Scholar 20 : Risk of prostate cancer-specific mortality following biochemical recurrence after radical prostatectomy. JAMA2005; 294: 433. Google Scholar James Buchanan Brady Urological Institute, and the Departments of Urology and Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland© 2006 by American Urological AssociationFiguresReferencesRelatedDetailsCited by (2018) Reply by AuthorsJournal of Urology, VOL. 184, NO. 4, (1572-1573), Online publication date: 1-Oct-2010.Related articlesJournal of Urology9 Nov 2018Radical Prostatectomy—Which Patients Benefit Most From Surgery? Volume 176Issue 2August 2006Page: 554-558 Advertisement Copyright & Permissions© 2006 by American Urological AssociationKeywordsbiopsyprostatectomyprostate-specific antigenprostatic neoplasmsMetricsAuthor Information Danil V. Makarov More articles by this author Elizabeth B. Humphreys More articles by this author Leslie A. Mangold More articles by this author Patrick C. Walsh More articles by this author Alan W. Partin More articles by this author Jonathan I. Epstein More articles by this author Stephen J. Freedland More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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• W2014408086 title "Pathological Outcomes and Biochemical Progression in Men With T1c Prostate Cancer Undergoing Radical Prostatectomy With Prostate Specific Antigen 2.6 to 4.0 vs 4.1 to 6.0 ng/ml" @default.
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