[Secondary biological recurrence after radical prostatectomy: multivariate analysis of prognostic clinical, biological, and histologic factors].
OBJECTIVE
To define the clinical, laboratory and histological variables associated with secondary elevation, after an undetectable phase, of PSA after radical prostatectomy.


METHODS
This was a prospective study of 83 consecutive patients undergoing retropubic radical prostatectomy with an undetectable postoperative PSA at 3 months. The predictive value of five preoperative criteria (age, total PSA, Gleason score on biopsies, positive apical biopsies, clinical stage) and four postoperative criteria (pathological stage, Gleason score on the operative specimen, positive margins, follow-up) for secondary laboratory progression was studied by univariate and multivariate analysis.


RESULTS
With a median follow-up of 36 months, the laboratory recurrence rate was 19%. Laboratory recurrence was associated with a biopsy Gleason score greater than or equal to 7 (p = 0.04), a high pathological stage (p = 0.03), a high histological score (Gleason > or = 7) (p < 0.01) and positive margins (p = 0.04). Logistic regression identified a Gleason score on the operative specimen greater than or equal to 7 to be the only element predictive of secondary laboratory progression.


CONCLUSIONS
The concept of positive margins or high pathological stage is insufficient to identify the risk of laboratory progression after radical prostatectomy. The Gleason score, which evaluates tumour aggressiveness, the risk of micrometastases or periprostatic extension, therefore appears to be more useful.
Malavaud
B
B
Service de Chirurgie Urologique et de Transplantation Rénale, Hôpital Rangueil, Toulouse, France. malavaud.b@chu-toulouse.fr
Game
X
X
Villers
A
A
Mouzin
M
M
Mazerolles
C
C
Rischmann
P
P
Sarramon
J P
JP
D000230:Adenocarcinoma / Q000097:blood / Q000473:pathology* / Q000601:surgery*; D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000473:pathology*; D011379:Prognosis; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery*
D017430:Prostate-Specific Antigen