Comparison of observed biochemical recurrence-free survival in patients with low PSA values undergoing radical prostatectomy and predictions of preoperative nomogram Journal Article

   

Authors:	Berglund, R. K.; Stephenson, A. J.; Cronin, A. M.; Vickers, A. J.; Eastham, J. A.; Klein, E. A.; Guillonneau, B. D.
Article Title:	Comparison of observed biochemical recurrence-free survival in patients with low PSA values undergoing radical prostatectomy and predictions of preoperative nomogram
Abstract:	Objectives: A preoperative nomogram is an effective tool for assessing the risk of disease progression after radical prostatectomy for localized prostate cancer. To better understand the performance of nomograms for patients with a low prostate-specific antigen (PSA) level, we examined whether patients with a PSA level <2.5 ng/mL had outcomes different than predicted by a validated preoperative nomogram. Methods: A cohort of 6130 patients from 2 referral centers was analyzed. Kaplan-Meier methods were used to estimate the recurrence-free probabilities stratified by PSA group (<2.5 vs ≥2.5 ng/mL). Cox proportional hazards regression analysis was used to evaluate whether the PSA grouping was associated with biochemical recurrence, controlling for preoperative nomogram probability. Results: Of 6130 patients, 399 (6.5%) had a PSA level <2.5 ng/mL. Patients with a PSA level of ≤0.5 ng/mL had a high rate of nonorgan-confined disease (33% vs 15% for PSA levels of 0.6-2.5 ng/mL). The median follow-up for recurrence-free patients was 2.4 years, and 10 patients with a PSA level of <2.5 ng/mL and 597 patients with a PSA level >2.5 ng/mL developed recurrence (total 607/6130). With adjustment for the preoperative nomogram probability, no significant difference was found in recurrence by PSA grouping (hazard ratio 0.78 for PSA <2.5 vs ≥2.5 ng/mL; 95% confidence interval 0.42-1.48; P = .5). Conclusions: Patients with a low PSA comprise a small proportion of those treated, and most have palpable disease. Patients with especially low PSA values (≤0.5 ng/mL) have a high rate of nonorgan-confined disease. We saw no evidence that patients with low PSA levels have worse outcomes, after the stage and grade were taken into account. © 2009 Elsevier Inc. All rights reserved.
Keywords:	immunohistochemistry; adult; cancer survival; treatment outcome; aged; disease-free survival; middle aged; survival rate; retrospective studies; major clinical study; cancer recurrence; preoperative care; cancer staging; follow-up studies; neoplasm staging; cancer grading; preoperative evaluation; sensitivity and specificity; prostate specific antigen; cohort studies; neoplasm recurrence, local; cohort analysis; prediction; risk assessment; prostate cancer; prostate-specific antigen; prostatic neoplasms; probability; prostatectomy; biopsy, needle; nomograms
Journal Title:	Urology
Volume:	73
Issue:	5
ISSN:	0090-4295
Publisher:	Elsevier Science, Inc.
Date Published:	2009-05-01
Start Page:	1098
End Page:	1103
Language:	English
DOI:	10.1016/j.urology.2008.07.052
PUBMED:	19278718
PROVIDER:	scopus
PMCID:	PMC2834301
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-65049090812&partnerID=40&md5=d311797961532cca1cdd4732a87fb255
Notes:	--- - "Export Date: 30 November 2010" - "CODEN: URGYA" - "Source: Scopus"

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