PSA PERSISTENCE AFTER RADICAL PROSTATECTOMY IN PATIENTS WITH CN0M0 PROSTATE CANCER, NEGATIVE MARGINS AND NEGATIVE NODES AT FINAL PATHOLOGY: PRE- AND POST-OPERATIVE RISK FACTORS

Giuseppe Reitano, Daniel Roberson, Jamie O'Byrne,Mohamed Ahmed,Umar Ghaffar,Spyridon Basourakos, Julian Diaz-Cobo,Stephen Boorjian,Igor Frank, Matthew Gettman,Matthew Tollefson,R. Jeffrey Karnes

Urologic Oncology Seminars and Original Investigations（2025）

Urology Department - Mayo Clinic

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Abstract

Introduction Biochemical failure (BCF) after radical prostatectomy seems to increase the risk of disease recurrence and cancer specific mortality. The primary objective of this study is to explore potential peri-operative features that may predict an increased risk of PSA persistence, or BCF, following surgery. We specifically sought to investigate the role of preoperative MRI in predicting this outcome. Methods Patients treated at a single institution between 2006 and 2022 were identified from a prospectively maintained institutional registry. Our sample cohort included a total of 6833 men with negative pre-operative staging (cN0M0), and surgical pathology demonstrating negative margins and lymph nodes. Two measure PSA levels ≥ 0.1 ng/ml within 4-6 weeks after surgery was used as our definition of BCF. Logistic regression analysis was performed to generate odds ratios (OR) and assess the association between peri-operative risk factors and BCF. Features of interest included age, ethnicity, smoking status, pre-operative PSA, and clinical T stage (cT) based on the multiparametric magnetic resonance (mpMRI). Gleason score (GS) at diagnosis, pathological GS, tumor volume, pathological T stage (pT), and lymphovascular invasion (LVI) were analyzed as pathological factors. Results The patients were divided into two groups based on post-operative PSA value. 6263 did not have PSA persistence, while 570 met our definition of BCF. The median age was 62 years (IQR 57-67) for the patients without persistence, and 63 years (IQR 57-67) for those who had BCF. Median PSA was higher among patients with PSA persistence (6.3, IQR 4.5,10.3) compared to those without (5.7 ng/ml, IQR 4.2-8.0). Patients with BCF had a higher proportion of cT stage ≥ 3a at mpMRI (26.7% versus 18.7%) than patients with no BCF. Univariable logistic regression showed a statistically significant association between pathological and preoperative GS, cT and pT stage, LVI, tumor volume and history of smoking. In multivariable analysis, the association remained statistically significant only for definitive pathological features and the history of tobacco use. Results of the uni- and multivariable analyses are presented in table 1. Confounding assessment showed that smoking may confound the association between cT-stage, GS, and tumor volume. Conclusions Several pathological risk factors may increase the risk of PSA persistence after radical prostatectomy in patients who have localized disease preoperatively and pathologically and negative margins at surgery Understanding these predictors can serve as a valuable tool in patient counseling through the course of prostate cancer treatment.

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【要点】：本研究探讨了术后PSA持续存在的风险因素，特别是术前MRI在预测PSA持续存在（生化失败）中的作用。

【方法】：通过单机构前瞻性登记的数据，对6833名术前分期为cN0M0、手术病理显示切缘和淋巴结阴性的男性患者进行了逻辑回归分析，评估围手术期风险因素与生化失败之间的关系。

【实验】：实验将患者分为两组，一组6263名患者未出现PSA持续存在，另一组570名患者符合生化失败的界定标准。通过单变量和多变量逻辑回归分析，研究了年龄、种族、吸烟状况、术前PSA、临床T分期等术前特征以及病理学特征如Gleason评分、肿瘤体积、病理T分期和淋巴血管侵犯等与PSA持续存在的关系。实验结果显示，术后PSA持续存在组患者的平均年龄和术前PSA水平均高于无PSA持续存在组，且术后PSA持续存在组在mpMRI上cT3a期比例更高。在多变量分析中，只有确定性病理特征和吸烟史与PSA持续存在显著相关。数据集名称未在文中提及。