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. 2021 May 18;13(10):2453.
doi: 10.3390/cancers13102453.

The Significance of Prostate Specific Antigen Persistence in Prostate Cancer Risk Groups on Long-Term Oncological Outcomes

Daimantas Milonas  1 , Zilvinas Venclovas  1 , Gustas Sasnauskas  1 , Tomas Ruzgas  2
Affiliations

The Significance of Prostate Specific Antigen Persistence in Prostate Cancer Risk Groups on Long-Term Oncological Outcomes

Daimantas Milonas et al. Cancers (Basel). .

Abstract

Objective: To assess the significance of prostate-specific antigen (PSA) persistence at the first measurement after radical prostatectomy (RP) on long-term outcomes in different prostate cancer risk groups.

Methods: Persistent PSA was defined as ≥0.1 ng/mL at 4-8 weeks after RP. Patients were stratified into low-, intermediate- and high-risk groups, according to the preoperative PSA, pathological stage, grade group and lymph nodes status. The ten-year cumulative incidence of biochemical recurrence (BCR), metastases, cancer-specific mortality (CSM) and overall mortality (OM) were calculated in patients with undetectable and persistent PSA in different PCa-risk groups. Multivariate regression analyses depicted the significance of PSA persistence on each study endpoint.

Results: Of all 1225 men, in 246 (20.1%), PSA persistence was detected. These men had an increased risk of BCR (hazard ratio (HR) 4.2, p < 0.0001), metastases (HR: 2.7, p = 0.002), CRM (HR: 5.5, p = 0.002) and OM (HR: 1.8, p = 0.01) compared to the men with undetectable PSA. The same significance of PSA persistence on each study endpoint was found in the high-risk group (HR: 2.5 to 6.2, p = 0.02 to p < 0.0001). In the intermediate-risk group, PSA persistence was found as a predictor of BCR (HR: 3.9, p < 0.0001), while, in the low-risk group, PSA persistence was not detected as a significant predictor of outcomes after RP.

Conclusions: Persistent PSA could be used as an independent predictor of worse long-term outcomes in high-risk PCa patients, while, in intermediate-risk patients, this parameter significantly predicts only biochemical recurrence and has no impact on the outcomes in low-risk PCa patients.

Keywords: PSA persistence; outcomes; prostate cancer; radical prostatectomy; risk groups.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Study flowchart. RP—radical prostatectomy, PCa—prostate cancer, GG—grade groups and PSA—prostate-specific antigen.
Figure 2
Figure 2
Cumulative incidence function for biochemical recurrence (BCR), metastases (MTS), cancer-specific mortality (CSM) and overall mortality (OM) in all study cohort patients with undetectable vs. persistent prostate-specific antigen (PSA).
Figure 3
Figure 3
Cumulative incidence function for biochemical recurrence (BCR), metastases (MTS), cancer-specific mortality(CSM) and overall mortality (OM) in low-risk patients with undetectable vs. persistent prostate-specific antigen (PSA).
Figure 4
Figure 4
Cumulative incidence function for biochemical recurrence (BCR), metastases (MTS), cancer-specific mortality (CSM) and overall mortality (OM) in intermediate-risk patients with undetectable vs. persistent prostate-specific antigen (PSA).
Figure 5
Figure 5
Cumulative incidence function for biochemical recurrence (BCR), metastases (MTS), cancer-specific mortality (CSM) and overall mortality (OM) in high-risk patients with undetectable vs. persistent prostate-specific antigen (PSA).
Figure 5
Figure 5
Cumulative incidence function for biochemical recurrence (BCR), metastases (MTS), cancer-specific mortality (CSM) and overall mortality (OM) in high-risk patients with undetectable vs. persistent prostate-specific antigen (PSA).
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