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Urol Oncol. 2018 May;36(5):239.e17-239.e25. doi: 10.1016/j.urolonc.2018.01.005. Epub 2018 Feb 9.

First postoperative PSA is associated with outcomes in patients with node positive prostate cancer: Results from the SEARCH database.

Author information

1
Urology Department, University of California San Diego Health System, San Diego, CA.
2
Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC; Division of Urology, Veterans Affairs Medical Center, Durham, NC.
3
Department of Urology, UCLA School of Medicine, Los Angeles, CA; Department of Surgery, Urology Section, Veterans Affairs Greater Los Angeles, Los Angeles, CA.
4
Section of Urology, Veterans Affairs Medical Center, Augusta, GA; Section of Urology, Medical College of Georgia, Augusta, GA.
5
Department of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA.
6
Department of Surgery, Oregon Health and Science University, Portland, OR.
7
Division of Urology, Veterans Affairs Medical Center, Durham, NC; Department of Surgery, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA.
8
Urology Department, University of California San Diego Health System, San Diego, CA. Electronic address: ckane@ucsd.edu.

Abstract

OBJECTIVE:

To analyze factors associated with metastases, prostate cancer-specific mortality, and all-cause mortality in pN1 patients.

MATERIALS AND METHODS:

We analyzed 3,642 radical prostatectomy patients within the Shared Equal Access Regional Cancer Hospital (SEARCH) database. Pathologic Gleason grade, number of lymph nodes (LN) removed, and first postoperative prostate-specific antigen (PSA) (<0.2 ng/ml or ≥0.2 ng/ml) were among covariates assessed. Cox regression was used to analyze the association between characteristics and survival outcomes. Kaplan-Meier was used to estimate survival in pN1 patients stratified by first postoperative PSA.

RESULTS:

Of 3,642 patients, 124 (3.4%) had pN1. There were 71 (60%) patients with 1 positive LN, 32 (27%) with 2 positive LNs, and 15 (13%) with ≥3. Among men with pN1, first postoperative PSA was<0.2ng/ml in 46 patients (51%) and ≥0.2ng/ml in 44 patients (49%). Univariable Cox regression determined pathological Gleason grade (P = 0.021), seminal vesicle invasion (P = 0.010), and first postoperative PSA ≥0.2 ng/ml (P = 0.005) were associated with metastases. First postoperative PSA ≥0.2ng/ml was associated with metastasis on multivariable analysis (P = 0.046). Log-rank analysis revealed a more favorable metastases-free survival in patients with a first postoperative PSA<0.2ng/ml (P = 0.001). Estimated 5-year metastases-free survival rate was 99% for patients with a first postoperative PSA<0.2ng/ml and 87% for ≥0.2ng/ml.

CONCLUSIONS:

pN1 patients with a first postoperative PSA ≥0.2ng/ml were more likely to develop metastases. First postoperative PSA may be useful in identifying pN1 patients who harbor distant disease and aid in secondary treatment decisions.

KEYWORDS:

Lymph node; Metastases; PSA; Prostate neoplasms; Prostatectomy

PMID:
29429895
DOI:
10.1016/j.urolonc.2018.01.005
[Indexed for MEDLINE]

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