title: Pathological outcomes and biochemical progression in men with T1c prostate cancer undergoing radical prostatectomy with prostate specific antigen 2.6 to 4.0 vs 4.1 to 6.0 ng/ml.
abstract: OBJECTIVE
  Recent studies have suggested that the cut point for recommending prostate biopsy among men with a normal digital rectal examination should be greater than 2.5 ng/ml as opposed to the more traditional greater than 4.0 ng/ml. We compared outcomes between men with clinical stage T1c disease undergoing radical prostatectomy who had a low vs slightly increased prostate specific antigen.
  
  
  METHODS
  The study population consisted of 2,896 men treated with radical prostatectomy between 1985 and 2004 at a tertiary care referral center with clinical stage T1c disease and a pre-biopsy prostate specific antigen between 2.6 and 6.0 ng/ml. Using multivariate analysis we evaluated the association between pre-biopsy prostate specific antigen 2.6 to 4.0 ng/ml (784) vs 4.1 to 6.0 ng/ml (2,112), and pathological outcomes and biochemical progression.
  
  
  RESULTS
  After adjusting for multiple clinical and pathological characteristics, lower preoperative serum prostate specific antigen values were associated with decreased odds of Gleason score 7 or greater in the surgical specimen (p = 0.004), positive surgical margins (p = 0.02) and extraprostatic extension (p = 0.001). There was no significant association between these preoperative prostate specific antigen groups and odds of seminal vesicle invasion (p = 0.47) or lymph node metastasis (p = 0.90). Among the 1,534 men with followup information available there was a trend for increased risk of biochemical progression associated with a higher preoperative prostate specific antigen, although this trend did not reach statistical significance (relative risk 1.48, 95% CI 0.69-3.19, p = 0.31).
  
  
  CONCLUSIONS
  In the current study of men with clinical stage T1c treated with radical prostatectomy a lower preoperative prostate specific antigen was associated with significantly more favorable pathological findings. Whether this degree of improved outcomes justifies the limitations associated with decreasing the prostate specific antigen cut point (eg increased biopsies performed and diagnosis of insignificant cancers) remains to be determined.
authors.affiliation: James Buchanan Brady Urological Institute, and the Department of Urology, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA. dmakarov@jhmi.edu
authors.forename: Danil V
authors.initials: DV
authors.lastname: Makarov
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Humphreys
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Mangold
authors.forename: Patrick C
authors.initials: PC
authors.lastname: Walsh
authors.forename: Alan W
authors.initials: AW
authors.lastname: Partin
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Epstein
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Freedland
mesh_terms: D018450:Disease Progression; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood* / Q000473:pathology / Q000601:surgery*
chemical_list: D017430:Prostate-Specific Antigen