title: Delayed prostate-specific antigen recurrence after radical prostatectomy: how to identify and what are their clinical outcomes?
abstract: OBJECTIVE
  To identify factors that predict delayed (> 5 years) prostate-specific antigen recurrence (PSAR) after radical prostatectomy (RP) and to analyze the associated clinical outcomes.
  
  
  METHODS
  A cohort of 4561 men who underwent RP between 1988 and 2008 was retrieved from the Duke University Prostate Center database. Among them, 1207 (26.5%) had PSAR and were included in this study. The cohort was then divided into 2 groups; PSAR before 5 years (early PSAR) and PSAR after 5 years (delayed PSAR), and Kaplan Meier analysis was performed. Univariate and logistic regression analysis was carried out to determine significant predictors of delayed PSAR, using factors such as race, age, body mass index, PSA, surgical margin status, pathologic Gleason sum, pathologic tumor stage, and prostate weight.
  
  
  RESULTS
  There was a marginal difference between the early and delayed PSAR groups with regard to metastasis-free survival (P = .062). A significant difference in disease-specific survival was found between the 2 groups (P = .025). Patients with pathologic Gleason sums < 7 were more likely to have delayed PSAR as compared to those with pathologic Gleason sums > 7 (OR = 2.38). Patients with a PSA < 10 ng/mL were more likely to have delayed PSAR in comparison to those with PSA > 20 ng/mL (OR = 2.38).
  
  
  CONCLUSIONS
  Approximately 90% of PSAR occurred within 5 years after RP. Lower pathologic Gleason sums and lower PSA at diagnosis were associated with delayed PSAR. Patients with delayed PSAR have a disease-specific survival advantage as compared to men with early PSAR.
authors.affiliation: Division of Urology, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Arthur A
authors.initials: AA
authors.lastname: Caire
authors.forename: Leon
authors.initials: L
authors.lastname: Sun
authors.forename: Oludotun
authors.initials: O
authors.lastname: Ode
authors.forename: Danielle A
authors.initials: DA
authors.lastname: Stackhouse
authors.forename: Kelly
authors.initials: K
authors.lastname: Maloney
authors.forename: Craig
authors.initials: C
authors.lastname: Donatucci
authors.forename: Vladimir
authors.initials: V
authors.lastname: Mouraviev
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Polascik
authors.forename: Cary N
authors.initials: CN
authors.lastname: Robertson
authors.forename: David M
authors.initials: DM
authors.lastname: Albala
authors.forename: Judd W
authors.initials: JW
authors.lastname: Moul
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000097:blood* / Q000601:surgery*; D013997:Time Factors
chemical_list: D017430:Prostate-Specific Antigen