title: Comparison of oncologic outcomes after radical prostatectomy in men diagnosed with prostate cancer with PSA levels below and above 4 ng/mL.
abstract: OBJECTIVE
  To assess whether the PSA level (threshold 4 ng/mL) is a prognostic factor in biochemical recurrence-free survival in men with prostate cancer (PCa) with an initial PSA level <10 ng/mL who underwent robotic-assisted laparoscopic radical prostatectomy (RARLP).
  
  
  METHODS
  We prospectively recruited data for consecutive patients treated by RARLP for PCa with an initial PSA level below 10 ng/mL between 2003 and 2011 at our institution. We divided the population into two groups: patients with a PSA level below 4 ng/mL (G1; n = 53) and patients with a PSA level between 4 and 10 ng/mL (G2; n = 371). Biochemical recurrence was defined as a single increase in PSA greater than 0.2 ng/mL after surgery. Multivariate analysis was used to assess prognostic factors of recurrence-free survival.
  
  
  RESULTS
  Overall, 424 patients were included, and the median age was 62 (58-67) years. The median PSA was 5.8 ng/mL (4.8-7.7 ng/mL). Overall, 6 patients from G1 and 34 patients from G2 experienced a biochemical recurrence. Overall, the 5-year recurrence-free survival rate was 86.6 %. The PSA level at diagnosis (under or over 4 ng/mL) was not significantly linked to recurrence-free survival (HR = 0.59, p = 0.25). However, positive margins and a Gleason score >7 on the specimen were significantly linked to recurrence-free survival with respective hazard ratios of 4.30 (p < 0.0001) and 6.18 (p < 0.0001), respectively.
  
  
  CONCLUSIONS
  A PSA level <4 ng/mL alone appears to be obsolete as a cut-off to define a population of men likely to have indolent disease.
authors.affiliation: Academic Department of Urology, Pitié-Salpétrière hospital (Assistance Publique-Hôpitaux de Paris), 83, Boulevard de l'hôpital, 75013, Paris, France.
authors.forename: Charles
authors.initials: C
authors.lastname: Dariane
authors.forename: Chloé
authors.initials: C
authors.lastname: Le Cossec
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Drouin
authors.forename: Benoit
authors.initials: B
authors.lastname: Wolff
authors.forename: Benjamin
authors.initials: B
authors.lastname: Granger
authors.forename: Pierre
authors.initials: P
authors.lastname: Mozer
authors.forename: Marc-Olivier
authors.initials: MO
authors.lastname: Bitker
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Olivier
authors.initials: O
authors.lastname: Cussenot
authors.forename: Morgan
authors.initials: M
authors.lastname: Rouprêt
mesh_terms: D000368:Aged; D015331:Cohort Studies; D018572:Disease-Free Survival; D006801:Humans; D007610:Kallikreins / Q000097:blood*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000097:blood*; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood* / Q000601:surgery; D012371:Robotics; D016896:Treatment Outcome
chemical_list: C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen