• Logo
  • SBMUJournals

Factors Predicting Prostate Specific Antigen Failure Following Radical Prostatectomy: Experience with 961 Patients

Nasser Simforoosh, Mehdi Dadpour, pouria Mousapour, akbar Shafiee, Milad Bonakdar Hashemi
169

Views


Abstract

Objective: To determine disease-related predictors for the occurrence of prostate specific antigen (PSA) failure in Iranian prostate cancer patients who underwent radical prostatectomy.

Methods: In this cohort study, we enrolled eligible patients with prostate cancer who underwent radical prostatectomy at our center between 2001 and 2018. The primary endpoint was the incidence of postoperative biochemical failure, defined as two consecutive PSA levels ?0.2 ng/dl. Patients with TNM stage ? III, Gleason score ?8, or baseline PSA above our calculated cut-off level were considered as high risk. Kaplan–Meier survival method and Cox proportional hazards regression analysis were used for determining the biochemical relapse-free survival and its predictors.

Results: Data of 959 patients (age=61.2 ± 6.4 years) were analyzed with a median follow up of 36 months (range 6 months to 18 years). A total of 97 patients (10.1%) developed biochemical failure at the time of analysis who had a significantly older age and longer follow-up duration (P=0.024 and P<0.001, respectively). Preoperative PSA level of 8.85 mg/dl could predict the occurrence biochemical failure with a sensitivity of 83.2% and specificity of 39.2% (Area under the curve=0.601, 95% CI: 0.541-0.662; P=0.001). In the multivariate analysis, higher preoperative PSA, Gleason score?8, and high-risk TNM stage were independent predictors for biochemical relapse (P=0.029, P=0.001, and P=0.008, respectively).

Conclusion: Preoperative PSA, Gleason score, and TNM stage were independent predictors for biochemical failure following radical prostatectomy in prostate cancer patients. We also determined a lower cut-point for PSA that could predict biochemical failure.


Keywords

Prostate Cancer; Biochemical Failure; Cohort study; Survival Rate; Risk Factors

References

REFERENCES

Pakzad R, Rafiemanesh H, Ghoncheh M, et al. Prostate Cancer in Iran: Trends in Incidence and Morphological and Epidemiological Characteristics. Asian Pac J Cancer Prev. 2016;17:839-43.

Haddad-Khoshkar A, Jafari-Koshki T, Mahaki B. Investigating the Incidence of Prostate Cancer in Iran 2005 -2008 using Bayesian Spatial Ecological Regression Models. Asian Pac J Cancer Prev. 2015;16:5917-21.

Simforoosh N, Dadpour M, Mofid B. Cytoreductive and Palliative Radical Prostatectomy, Extended Lymphadenectomy and Bilateral Orchiectomy in Advanced Prostate Cancer with Oligo and Widespread Bone Metastases: Result of a Feasibility, Our Initial Experience. Urol J. 2018.

Hassanipour S, Fathalipour M, Salehiniya H. The incidence of prostate cancer in Iran: a systematic review and meta-analysis. Prostate Int. 2018;6:41-5.

Vollmer RT. Gleason Grading, Biochemical Failure, and Prostate Cancer-Specific Death. Am J Clin Pathol. 2017;147:273-7.

Nguyen T, Boldt RG, Rodrigues G. Prognostic Factors for Prostate Cancer Endpoints Following Biochemical Failure: A Review of the Literature. Cureus. 2015;7:e238.

Tollefson MK, Leibovich BC, Slezak JM, Zincke H, Blute ML. Long-term prognostic significance of primary Gleason pattern in patients with Gleason score 7 prostate cancer: impact on prostate cancer specific survival. J Urol. 2006;175:547-51.

Mohideen MN, McCall AR, Feinstein J, Sidrys J, Bricker P, Luka S. Factors that influence biochemical failure after radiation therapy for stage T1c prostate cancer. Am J Clin Oncol. 1998;21:6-11.

Sanda MG, Cadeddu JA, Kirkby E, et al. Clinically Localized Prostate Cancer: AUA/ASTRO/SUO Guideline. Part II: Recommended Approaches and Details of Specific Care Options. J Urol. 2018;199:990-7.

Sanda MG, Cadeddu JA, Kirkby E, et al. Clinically Localized Prostate Cancer: AUA/ASTRO/SUO Guideline. Part I: Risk Stratification, Shared Decision Making, and Care Options. J Urol. 2018;199:683-90.

Kolahdoozan S, Sadjadi A, Radmard AR, Khademi H. Five common cancers in Iran. Arch Iran Med. 2010;13:143-6.

Zhang K, Bangma CH, Roobol MJ. Prostate cancer screening in Europe and Asia. Asian journal of urology. 2017;4:86-95.

Vassil AD, Murphy ES, Reddy CA, et al. Five year biochemical recurrence free survival for intermediate risk prostate cancer after radical prostatectomy, external beam radiation therapy or permanent seed implantation. 2010;76:1251-7.

Nguyen PL, D'amico AV, Lee AK, Warren Suh WJCIIJotACS. Patient selection, cancer control, and complications after salvage local therapy for postradiation prostate‐specific antigen failure: a systematic review of the literature. 2007;110:1417-28.

Gonzalez-San Segundo C, Jove J, Zapatero A, et al. Survival after biochemical failure in prostate cancer treated with radiotherapy: Spanish Registry of Prostate Cancer (RECAP) database outcomes. Clin Transl Oncol. 2019.

Taussky D, Lambert C, Meissner N, Bahary JP, Delouya G. Risk factors for biochemical recurrence after a tissue-ablative prostate-specific antigen <0.2 ng/mL. Brachytherapy. 2018;17:794-8.

Hu M-B, Xu H, Bai P-D, Jiang H-W, Ding QJMO. Obesity has multifaceted impact on biochemical recurrence of prostate cancer: a dose–response meta-analysis of 36,927 patients. 2014;31:829.

Goto K, Nagamatsu H, Teishima J, et al. Body mass index as a classifier to predict biochemical recurrence after radical prostatectomy in patients with lower prostate-specific antigen levels. Mol Clin Oncol. 2017;6:748-52.

Maj-Hes AB, Mathieu R, Ozsoy M, et al. Obesity is associated with biochemical recurrence after radical prostatectomy: A multi-institutional extended validation study. Urol Oncol. 2017;35:460.e1-.e8.

Rieken M, Shariat SF, Kluth LA, et al. Association of Cigarette Smoking and Smoking Cessation with Biochemical Recurrence of Prostate Cancer in Patients Treated with Radical Prostatectomy. Eur Urol. 2015;68:949-56.

Joentausta RM, Rannikko A, Murtola TJ. Prostate cancer survival among statin users after prostatectomy in a Finnish nationwide cohort. Prostate. 2019;79:583-91.

Aminsharifi A, Howard LE, Amling CL, et al. Statins are Associated With Increased Biochemical Recurrence After Radical Prostatectomy in Diabetic Men but no Association was Seen in Men also Taking Metformin: Results From the SEARCH Database. Clin Genitourin Cancer. 2019;17:e140-e9.

Hao Q, Gong H, Zong H, et al. Aspirin use improves the biochemical control of prostate cancer in Chinese men. J buon. 2018;23:1803-8.

Zanaty M, Alnazari M, Ajib K, et al. Does surgical delay for radical prostatectomy affect biochemical recurrence? A retrospective analysis from a Canadian cohort. World J Urol. 2018;36:1-6.

Jiang Q, Xie M, He M, et al. PITX2 methylation: a novel and effective biomarker for monitoring biochemical recurrence risk of prostate cancer. Medicine (Baltimore). 2019;98:e13820.

Kurose H, Naito Y, Akiba J, et al. High sulfite oxidase expression could predict postoperative biochemical recurrence in patients with prostate cancer. Med Mol Morphol. 2019.

Lee H, Lee M, Hong SK. CRTC2 as a novel prognostic biomarker for worse pathologic outcomes and biochemical recurrence after radical prostatectomy in patients with prostate cancer. Investig Clin Urol. 2019;60:84-90.

Shao N, Zhu Y, Wan FN, Ye DW. Identification of seven long noncoding RNAs signature for prediction of biochemical recurrence in prostate cancer. Asian J Androl. 2019.

Zhang LJ, Wu B, Zha ZL, et al. Perineural invasion as an independent predictor of biochemical recurrence in prostate cancer following radical prostatectomy or radiotherapy: a systematic review and meta-analysis. BMC Urol. 2018;18:5.

Meng Y, Liao YB, Xu P, Wei WR, Wang J. Perineural invasion is an independent predictor of biochemical recurrence of prostate cancer after local treatment: a meta-analysis. Int J Clin Exp Med. 2015;8:13267-74.

Reeves FA, Battye S, Roth H, et al. Prostatic nerve subtypes independently predict biochemical recurrence in prostate cancer. J Clin Neurosci. 2019;63:213-9.

Liu H, Zhou H, Yan L, et al. Prognostic significance of six clinicopathological features for biochemical recurrence after radical prostatectomy: a systematic review and meta-analysis. Oncotarget. 2018;9:32238-49.

Kang M, Oh JJ, Lee S, Hong SK, Lee SE, Byun SS. Perineural Invasion and Lymphovascular Invasion are Associated with Increased Risk of Biochemical Recurrence in Patients Undergoing Radical Prostatectomy. Ann Surg Oncol. 2016;23:2699-706.

Ikeda M, Amano N, Sakata Y, et al. Gleason Pattern 5 is a Possible Pathologic Predictor for Biochemical Recurrence after Laparoscopic Radical Prostatectomy. Asian Pac J Cancer Prev. 2019;20:783-8.

Kanehira M, Takata R, Ishii S, et al. Predictive factors for short-term biochemical recurrence-free survival after robot-assisted laparoscopic radical prostatectomy in high-risk prostate cancer patients. Int J Clin Oncol. 2019.

Morris WJ, Pickles T, Keyes M. Using a surgical prostate-specific antigen threshold of >0.2 ng/mL to define biochemical failure for intermediate- and high-risk prostate cancer patients treated with definitive radiation therapy in the ASCENDE-RT randomized control trial. Brachytherapy. 2018;17:837-44.

Garcia-Barreras S, Sanchez-Salas R, Mejia-Monasterio C, et al. Biochemical recurrence-free conditional probability after radical prostatectomy: A dynamic prognosis. Int J Urol. 2019.

Gasinska A, Jaszczynski J, Rychlik U, Luczynska E, Pogodzinski M, Palaczynski M. Prognostic Significance of Serum PSA Level and Telomerase, VEGF and GLUT-1 Protein Expression for the Biochemical Recurrence in Prostate Cancer Patients after Radical Prostatectomy. Pathol Oncol Res. 2019.

Chapin BF, Nguyen JN, Achim MF, et al. Positive margin length and highest Gleason grade of tumor at the margin predict for biochemical recurrence after radical prostatectomy in patients with organ-confined prostate cancer. Prostate Cancer Prostatic Dis. 2018;21:221-7.

Rouanne M, Rode J, Campeggi A, et al. Long-term impact of positive surgical margins on biochemical recurrence after radical prostatectomy: ten years of follow-up. Scand J Urol. 2014;48:131-7.

Negishi T, Kuroiwa K, Hori Y, et al. Predictive factors of late biochemical recurrence after radical prostatectomy. Jpn J Clin Oncol. 2017;47:233-8.

Furubayashi N, Negishi T, Iwai H, et al. Biochemical failure after radical prostatectomy in intermediate-risk group men increases with the number of risk factors. Indian J Urol. 2017;33:64-9.

Beauval JB, Roumiguie M, Filleron T, et al. Biochemical recurrence-free survival and pathological outcomes after radical prostatectomy for high-risk prostate cancer. BMC Urol. 2016;16:26.

Murata Y, Tatsugami K, Yoshikawa M, et al. Predictive factors of biochemical recurrence after radical prostatectomy for high-risk prostate cancer. Int J Urol. 2018;25:284-9.




DOI: http://dx.doi.org/10.22037/uj.v0i0.5670

Refbacks

  • There are currently no refbacks.