The combination of preoperative prostate specific antigen and postoperative pathological findings to predict prostate specific antigen outcome in clinically localized prostate cancer.
OBJECTIVE
The independent clinical and pathological predictors of time to postoperative prostate specific antigen (PSA) failure were used to identify prostate cancer patients at high risk for this end point.


METHODS
A Cox regression multivariate analysis was used to determine the prognostic significance of preoperative PSA, pathological stage, prostatectomy Gleason score and margin status in predicting the time to postoperative PSA failure in 862 men with palpable (T2) or PSA detected (T1c) prostate cancer. The 2-year PSA failure rates with 95% confidence intervals were calculated using the results of Cox regression analysis and a bootstrap procedure with 2,000 replications, respectively, and are presented in nomogram format stratified by preoperative PSA, pathological stage, prostatectomy Gleason score and margin status.


RESULTS
Preoperative PSA (p = 0.0001), pathological stage (p< or =0.002), margin status (p = 0.0001) and prostatectomy Gleason score (p = 0.034) were independent predictors of time to postoperative PSA failure.


CONCLUSIONS
Patients at high risk for early PSA failure could be identified postoperatively on the basis of preoperative PSA and prostatectomy pathology. Adjuvant therapy trials in these select patients may be justified.
D'Amico
A V
AV
Department of Radiation Oncology, Hospital of University of Pennsylvania, Philadelphia, USA.
Whittington
R
R
Malkowicz
S B
SB
Fondurulia
J
J
Chen
M H
MH
Tomaszewski
J E
JE
Wein
A
A
D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011300:Preoperative Care; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000473:pathology*; D012044:Regression Analysis
D017430:Prostate-Specific Antigen