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

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 ³0.1 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.

Clinicopathological and oncological significance of persistent prostate-specific antigen after radical prostatectomy: A systematic review and meta-analysis

“…Finally, a total of 32 studies published from 1990 to 2021 were included in the current study ( Table 1 ). Of these 32 studies, 11 included 26 719 patients from cohorts with consecutive patients [ [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , 35 , 36 ] and the remaining 21 comprised 24 177 patients from cohorts with specific restrictions such as high-risk PCa, LNI, persistent PSA only, or receipt of SRT or ART treatment [ [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , 30 , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] ]. The majority of the studies with consecutive patient cohort was of high quality with seven or more stars according to Newcastle-Ottawa Scale assessment ( Table 1 ).…”

“…Given the heterogeneity of cases with different specific restrictions, we only conducted the meta-analysis based on the studies from cohorts with consecutive patients. All 11 studies with consecutive patient cohort provided the data on comparing clinicopathological characteristics between patients with undetectable and persistent PSA, and were suitable for OR meta-analyses ( Table 2 ) [ [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , 35 , 36 ]. Furthermore, nine out of the 11 studies contained information on oncological outcomes ( Table 3 ) [ 8 , 10 , 11 , [13] , [14] , [15] , [16] , 35 , 36 ].…”

“…PSA of more than or equal to 0.1 ng/mL within 6 weeks after RP has been commonly used as the cutoff value to define persistent PSA in most of the prior studies [ [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] ]. The mechanism of persistent PSA has not been fully explored, and the potential explanations for persistent PSA were proposed to include residual benign prostate tissue, residual cancer burden from PSM, lymph node involvement (LNI), or occult micro-metastatic disease [ 29 ].…”

A New Goodness of Fit Test for Multivariate Normality and Comparative Simulation Study

“…The data set collected in 2001-2020 by the Head of the Department of Urology Clinic of the Lithuanian University of Health Sciences [27] illustrates the practical application. This dataset consists of study data from 2423 patients and two different continuous attributes (patient age and prostate-specific antigen (PSA)).…”

Goodness-of-Fit Test for the Bivariate Hermite Distribution

“…Since the chi-square test was proposed and analyzed by Pearson in 1900 until today, new gof tests have been constructed and applied to continuous and discrete data. Just to mention some of the most recent publications, there are, for example, the works of: Ebner and Henze [1], Górecki, Horváth and Kokoszka [2], Puig and Weiβ [3], Arnastauskaitè et al [4], D örr, Ebner, and Henze [5]), Kolkiewicz, Rice, and Xie [6], Milonas et al [7], Di Noia et al [8], and Erlemann and Lindqvist [9].…”