The Predictive Role of Prostate-Specific Antigen Changes Following Transurethral Resection of the Prostate for Patients with Localized Prostate Cancer

Abstract

Regarding localized prostate cancer (PC), questions remain regarding which patients are appropriate candidates for conservative management. Some localized PC was an incidental finding in patients who received transurethral resection of the prostate (TURP) for urinary symptoms. It is known that TURP usually affects the level of prostate-specific antigen (PSA). In the present study, we examined whether changes in PSA levels after TURP possess a predictive value for localized PC. We retrospectively reviewed the clinical data of 846 early-stage PC patients who underwent TURP for urinary symptoms upon diagnosis at our hospital. Of 846 patients, 687 had tumor involvement in TURP specimens, and 362 had post-TURP PSA assessment. Our data revealed that, in addition to low GS and PSA levels at diagnosis, ≤5% tumor involvement in TURP specimens, greater PSA reduction (≥68%) following TURP, and post-TURP PSA ≤ 4 were significantly associated with better progression-free survival (PFS). Survival analysis revealed that the addition of prostate-directed local therapy significantly improved PFS in intermediate- and high-risk groups, but not in the low-risk group. Moreover, in the intermediate-risk group, local therapy improved PFS only for patients who were associated with post-TURP PSA > 4 ng/mL or <68% PSA reduction following TURP. We also found that local therapy had no obvious improvement in PFS for those with post-TURP ≤ 4 ng/mL regardless of pre-TURP PSA. In conclusion, conservative management is considered for patients at low or intermediate risk who have greater PSA reduction following TURP and low post-TURP PSA. Therefore, the levels of PSA following TURP might be helpful for risk stratification and the selection of patients for conservative management.

Keywords: PSA; TURP; conservative management; local treatment; prostate cancer.

Figure 1

Survival in patients with early stage prostate cancer. We enrolled the patients with clinical stage T1–T2N0M0 prostate cancer who underwent transurethral resection of the prostate (TURP) into our present study. The study flow chart was presented in (a). Additional, Kaplan–Meier survival curves of progression-free survival (PFS) stratified by the addition of local therapy (b).

Figure 2

Factors correlated with clinical outcome of patients with localized prostate cancer. Kaplan-Meier PFS survival curves of 687 patients stratified by risk groups (a). Additional, local therapy significantly improved PFS when patients were stratified by clinical risk factors (b).

Figure 3

Tumor involvement in TURP prostatic tissue correlated with clinical outcome of patients with localized prostate cancer. Kaplan-Meier PFS survival curves of patients stratified by the percentage of tumor involvement in TURP specimens (a). Additional, local therapy significantly improved PFS in patients who produced TURP specimens with >5% tumor involvement but did not significantly benefit those with ≤5% tumor involvement (b).

Figure 4

PSA reduction following TURP correlated with clinical outcome of patients with localized prostate cancer. Kaplan-Meier PFS survival curves showed that ≥68% PSA reduction following TURP was associated with better PFS in patients with higher PSA_Dx, but not for patients with lower PSA_Dx (a). Additionally, for patients in the intermediate-risk group, local therapy significantly improved the prognosis for patients with the PSA reduction <68%, but not for patients with greater PSA reduction (b).

Figure 5

Predictive role of PSA level after TURP. Kaplan-Meier PFS survival curves of 362 patients stratified by PSA levels after TURP ≤ 4 ng/mL (versus > 4 ng/mL) (a). Survival difference in patients according to PSA levels at diagnosis combined with that after TURP (b). Additionally, local therapy significantly improved PFS when patients were stratified by the pathologic finding of TURP and changes in PSA (c). *, Statistical significance.

Figure 6

Predictive role of PSA level after TURP in low- and intermediate-risk group. For patients in the intermediate-risk group, local therapy significantly improved the prognosis for patients with high PSA_TURP but not for patients with PSA_TURP ≤ 4 ng/mL (a). For patients with GS < 7, local therapy significantly improved the prognosis for patients with high PSA_TURP but not for patients with PSA_TURP ≤ 4 ng/mL regardless of pre-TURP PSA ≤ 10 or >10 ng/mL (b).