The Association between pre-operative PSA and prostate cancer-specific mortality in patients with long-term follow-up after radical prostatectomy

BACKGROUND The clinical and pathologic predictors of prostate cancer-specific mortality (PCSM) many years after radical prostatectomy (RP) remain to be fully elucidated. We explored the association between pre-operative prostate-specific antigen (PSA) and other pathologic predictors and PCSM in men who have undergone (RP). METHODS. We report on 459 patients with PCSM data after RP who were followed prospectively over a 23-year period between 1987 and 1997. Cox regression and Kaplan-Meier analysis were used to evaluate pre-operative PSA, pathologic Gleason sum, pathologic stage, and surgical margin status as predictors of PCSM. RESULTS. The median PSA was 6.6 ng/ml (+/- 9.9) and the median follow-up time was 9.4 (+/- 4.9) years. Fourteen patients (3.1%) died of PC. On multivariate analysis, only PSA (HR: 1.050; P 0.001) and binary Gleason sum (HR: 3.402; P 0.043) remained significant predictors of PCSM. The predicted 10-year PCSM was significantly worse in those patients in the highest PSA tertile compared to those in other tertiles [PSA > 9.9: 87% (82-92%) vs. PSA 4-9.9: 95% (93.0-97.0%) vs. PSA 0-3.9: 100.0% (100.0-100.0%)]. CONCLUSIONS. We have highlighted the importance of pre-operative PSA in predicting PCSM many years after RP. It is a more significant predictor than Gleason sum and pathologic stage. Thus, PSA may help identify patients with life-threatening PC at a time when their disease is curable with definitive therapy. Prostate 72: 24-29, 2012. (C)d 2011 Wiley Periodicals, Inc.