title: Adverse pathology and undetectable ultrasensitive prostate-specific antigen after radical prostatectomy: is adjuvant radiation warranted?
abstract: To determine if men with adverse pathology but undetectable ultrasensitive (<0.01 ng/mL) PSA are at high-risk for biochemical recurrence (BCR), or if there is a subset of patients at low-risk for whom the benefit of adjuvant radiation therapy might be limited.
  
  
  
  We evaluated 411 patients treated with RP from 2001 to 2013 without adjuvant radiation who had an undetectable (<0.01 ng/mL) PSA level after RP but with adverse pathology [positive surgical margins (PSMs), extraprostatic extension (EPE), and/or seminal vesicle invasion (SVI)]. Multivariable Cox regression analyses tested the relationship between pathological characteristics and BCR to identify groups of men at highest risk of early BCR.
  
  
  
  On multivariable analysis, only pathological Gleason 7 (4 + 3), Gleason ≥8, and SVI independently predicted BCR (P = 0.019, P < 0.001, and P = 0.001, respectively), although on two-way analysis men with Gleason 7 (4 + 3) did not have significantly higher rates of BCR compared with patients with Gleason ≤6 (log-rank, P = 0.074). Men with either Gleason ≥8 (with PSMs or EPE) or SVI (15% of the cohort) defined a high-risk group vs men without these characteristics (3-year BCR risk of 50.4% vs 11.9%, log-rank, P < 0.001).
  
  
  
  Among men with adverse pathology but an undetectable (<0.01 ng/mL) PSA level after RP, the benefits of adjuvant radiation are probably limited except for men with Gleason 8-10 (with PSMs or EPE) or SVI who are at high-risk of early BCR.
authors.affiliation: Duke Prostate Center, Division of Urology, Department of Surgery and Pathology, Duke University School of Medicine, Durham, NC, USA.|Urology Section, Veterans Affairs Medical Center, Durham, NC, USA.
authors.forename: Ross M
authors.initials: RM
authors.lastname: Simon
authors.affiliation: Duke Prostate Center, Division of Urology, Department of Surgery and Pathology, Duke University School of Medicine, Durham, NC, USA.|Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA.
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Howard
authors.affiliation: Department of Surgery, Division of Urology, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Freedland
authors.affiliation: Urology Section, Department of Surgery, Veterans Affairs Medical Center of Greater Los Angeles, Los Angeles, CA, USA.|Department of Urology, University of California at Los Angeles Medical Center, Los Angeles, CA, USA.
authors.forename: William J
authors.initials: WJ
authors.lastname: Aronson
authors.affiliation: Urology Section, Division of Surgery, Veterans Affairs Medical Center, Augusta, GA, USA.|Division of Urologic Surgery, Department of Surgery, Medical College of Georgia, Augusta, GA, USA.
authors.forename: Martha K
authors.initials: MK
authors.lastname: Terris
authors.affiliation: Division of Urology, Department of Surgery, University of California at San Diego Medical Center, San Diego, CA, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Kane
authors.affiliation: Department of Urology, Oregon Health and Science University, Portland, OR, USA.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Amling
authors.affiliation: Department of Urology, University of California at San Francisco, San Francisco, CA, USA.|Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA, USA.|Urology Section, Department of Surgery, Veterans Affairs Medical Center, San Francisco, CA, USA.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Cooperberg
authors.affiliation: Department of Surgery, Division of Urology, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Adriana C
authors.initials: AC
authors.lastname: Vidal
mesh_terms: D014408:Biomarkers, Tumor / Q000097:blood; D003131:Combined Modality Therapy; D018450:Disease Progression; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D018365:Neoplasm, Residual / Q000473:pathology / Q000532:radiotherapy; D018579:Patient Selection; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D018714:Radiotherapy, Adjuvant / Q000379:methods; D012044:Regression Analysis; D012189:Retrospective Studies; D012669:Seminal Vesicles / Q000473:pathology*; D014481:United States; D014728:Veterans
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen
keywords: adjuvant radiotherapy; prostate; prostate-specific antigen; prostatic neoplasm; recurrence