Evaluating the Impact of PSA as a Selection Criteria for Nerve Sparing Radical Prostatectomy in a Screened Cohort.
Purpose. We investigated whether NS-RP increased risk of PSA failure and whether PSA should be included as a selection criterion for NS. Methods. We evaluated 357 consecutive men with screen-detected PC who underwent open RP without adjuvant radiotherapy between 9/11/2001 and 12/30/2008. Criteria for NS included Gleason score ≤3 + 4, percentage of positive biopsies (PPB) ≤50%, percentage of core involvement ≤50%, nonapical location, no perineural invasion, and no palpable disease on pre- or intraoperative exam but did not include a PSA threshold. Cox multivariable regression assessed whether increasing PSA or unilateral- or bilateral-NS versus non-NS-RP was associated with PSA failure adjusting for prognostic factors. Results. After a median follow-up of 3.96 years, 34 men sustained PSA failure (9.5%). Increasing PSA was significantly associated with increased risk of PSA failure in the interaction model (adjusted hazard ratio (AHR): 1.09 [95% CI: 1.03-1.16]; P = 0.005), whereas unilateral (AHR: 1.24 [95% CI: 0.36-4.34]; P = 0.73) or bilateral NS (AHR: 0.41 [95% CI: 0.06-2.59]; P = 0.34) versus non-NS RP was not. Conclusion. NS-RP in a screened cohort did not increase risk of PSA failure using NS criteria not including PSA.
Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA 02115, USA ; Brigham and Women's Hospital, 75 Francis Street, ASB1 L2, Boston, MA 02115, USA.
Shyam K
SK
Tanguturi
Department of Statistics, University of Connecticut, Storrs, CT 06269, USA.
Ming-Hui
MH
Chen
Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute, Boston, MA 02115, USA ; Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA 02115, USA.
Marian
M
Loffredo
Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute, Boston, MA 02115, USA.
Jerome P
JP
Richie
Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute, Boston, MA 02115, USA ; Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA 02115, USA.
Anthony V
AV
D'Amico