title: Predictors of short postoperative prostate-specific antigen doubling time for patients diagnosed during PSA era.
abstract: OBJECTIVE
  To determine the preoperative and postoperative predictors of a short prostate-specific antigen (PSA) doubling time (PSADT) after radical prostatectomy for patients diagnosed during the PSA era.
  
  
  METHODS
  Between 1989 and 2003, 1785 men underwent radical prostatectomy for 2002 American Joint Committee on Cancer (AJCC) Stage T1c or T2 prostate cancer. Of these men, 205 had documented PSA failure. The PSADT was calculated by assuming first-order kinetics and using a minimum of two detectable postoperative PSA measurements after a previous undetectable level. Multivariable logistic regression analyses were performed to determine the significant preoperative and postoperative predictors of a PSADT of less than 6 months.
  
  
  RESULTS
  Patients with a greater biopsy Gleason score (P = 0.006), greater preoperative risk group (P = 0.002), greater prostatectomy Gleason score (P = 0.0006), greater 2002 AJCC pathologic stage (P = 0.01), or shorter time to postoperative PSA failure (P = 0.04) were more likely to have a shorter PSADT. Using multivariable analysis, high-risk disease (P = 0.0001) was the only preoperative factor that remained an independent significant predictor of a PSADT of less than 6 months. Of the postoperative factors, a prostatectomy Gleason score of 8 to 10 (P = 0.002), 2002 AJCC pathologic Stage T3b (P = 0.03), and time to PSA failure of less than 2 years (P = 0.05) remained significant independent predictors of a PSADT of less than 6 months.
  
  
  CONCLUSIONS
  High-risk disease preoperatively and a prostatectomy Gleason score of 8 to 10, seminal vesicle invasion, or a time to PSA failure of less than 2 years postoperatively were significant independent indicators of developing a postoperative PSADT of less than 6 months. For these men, trials studying systemic therapy in addition to radical prostatectomy are needed.
authors.affiliation: Department of Urology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. dlin4@partners.org
authors.forename: Darlene D
authors.initials: DD
authors.lastname: Lin
authors.forename: Delray
authors.initials: D
authors.lastname: Schultz
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Renshaw
authors.forename: Mark A
authors.initials: MA
authors.lastname: Rubin
authors.forename: Jerome P
authors.initials: JP
authors.lastname: Richie
authors.forename: Anthony V
authors.initials: AV
authors.lastname: D'Amico
mesh_terms: D000328:Adult; D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood* / Q000601:surgery*; D013997:Time Factors
chemical_list: D017430:Prostate-Specific Antigen