Is prostate-specific antigen (PSA) density better than the preoperative PSA level in predicting early biochemical recurrence of prostate cancer after radical prostatectomy?

Timothy D. Jones, Michael Koch, Paula J. Bunde, Liang Cheng

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

OBJECTIVE: To investigate the relationship of preoperative prostate-specific antigen (PSA) level and PSA density with several clinical and pathological variables, including biochemical recurrence after radical prostatectomy (RP), and to compare the preoperative PSA level and PSA density as prognostic factors in prostate cancer. PATIENTS AND METHODS: The study included 348 patients who had a RP at one institution, with whole-mount specimens of the prostate examined by one pathologist. Univariate and multivariate analyses were used to assess the relationship of the preoperative PSA level and PSA density with clinical and pathological variables, and by receiver operating characteristic (ROC) analysis to evaluate the relative usefulness of the two factors as predictors for biochemical recurrence. RESULTS: The PSA level before RP was significantly correlated (Spearman's rank correlation) with patient age (P = 0.003), prostate weight (P < 0.001), cancer volume (P < 0.001) and Gleason score (P = 0.033), and with surgical margin status and pathological stage (both P < 0.001) in the RP specimen. In the multivariate analysis controlling for tumour stage, surgical margin status, and Gleason score, both PSA level and PSA density were significant predictors of PSA recurrence (P = 0.027 and 0.01, respectively). ROC analysis showed no statistical difference between the PSA level and PSA density in predicting PSA recurrence after RP (P = 0.40). CONCLUSIONS: These results show a significant correlation of the preoperative PSA level with other established prognostic factors for prostate cancer. In the multivariate analysis, both PSA level and PSA density were independent predictors of PSA recurrence. Because the PSA level is as effective as PSA density in predicting PSA recurrence, the extra effort required to calculate PSA density may not be warranted. We recommend that the PSA level before RP be considered in stratifying patients into different prognostic groups, and in determining the optimum management.

Original languageEnglish
Pages (from-to)480-484
Number of pages5
JournalBJU International
Volume97
Issue number3
DOIs
StatePublished - Mar 2006

Fingerprint

Prostate-Specific Antigen
Prostatectomy
Prostatic Neoplasms
Recurrence
Multivariate Analysis
Neoplasm Grading
ROC Curve
Prostate

Keywords

  • Biochemical recurrence
  • Neoplasm
  • Prognosis
  • Prostate
  • PSA
  • PSA density
  • Radical prostatectomy
  • Staging

ASJC Scopus subject areas

  • Urology

Cite this

@article{50429df384954ce291d6cc61e2616a6c,
title = "Is prostate-specific antigen (PSA) density better than the preoperative PSA level in predicting early biochemical recurrence of prostate cancer after radical prostatectomy?",
abstract = "OBJECTIVE: To investigate the relationship of preoperative prostate-specific antigen (PSA) level and PSA density with several clinical and pathological variables, including biochemical recurrence after radical prostatectomy (RP), and to compare the preoperative PSA level and PSA density as prognostic factors in prostate cancer. PATIENTS AND METHODS: The study included 348 patients who had a RP at one institution, with whole-mount specimens of the prostate examined by one pathologist. Univariate and multivariate analyses were used to assess the relationship of the preoperative PSA level and PSA density with clinical and pathological variables, and by receiver operating characteristic (ROC) analysis to evaluate the relative usefulness of the two factors as predictors for biochemical recurrence. RESULTS: The PSA level before RP was significantly correlated (Spearman's rank correlation) with patient age (P = 0.003), prostate weight (P < 0.001), cancer volume (P < 0.001) and Gleason score (P = 0.033), and with surgical margin status and pathological stage (both P < 0.001) in the RP specimen. In the multivariate analysis controlling for tumour stage, surgical margin status, and Gleason score, both PSA level and PSA density were significant predictors of PSA recurrence (P = 0.027 and 0.01, respectively). ROC analysis showed no statistical difference between the PSA level and PSA density in predicting PSA recurrence after RP (P = 0.40). CONCLUSIONS: These results show a significant correlation of the preoperative PSA level with other established prognostic factors for prostate cancer. In the multivariate analysis, both PSA level and PSA density were independent predictors of PSA recurrence. Because the PSA level is as effective as PSA density in predicting PSA recurrence, the extra effort required to calculate PSA density may not be warranted. We recommend that the PSA level before RP be considered in stratifying patients into different prognostic groups, and in determining the optimum management.",
keywords = "Biochemical recurrence, Neoplasm, Prognosis, Prostate, PSA, PSA density, Radical prostatectomy, Staging",
author = "Jones, {Timothy D.} and Michael Koch and Bunde, {Paula J.} and Liang Cheng",
year = "2006",
month = "3",
doi = "10.1111/j.1464-410X.2006.06022.x",
language = "English",
volume = "97",
pages = "480--484",
journal = "BJU International",
issn = "1464-4096",
publisher = "Wiley-Blackwell",
number = "3",

}

TY - JOUR

T1 - Is prostate-specific antigen (PSA) density better than the preoperative PSA level in predicting early biochemical recurrence of prostate cancer after radical prostatectomy?

AU - Jones, Timothy D.

AU - Koch, Michael

AU - Bunde, Paula J.

AU - Cheng, Liang

PY - 2006/3

Y1 - 2006/3

N2 - OBJECTIVE: To investigate the relationship of preoperative prostate-specific antigen (PSA) level and PSA density with several clinical and pathological variables, including biochemical recurrence after radical prostatectomy (RP), and to compare the preoperative PSA level and PSA density as prognostic factors in prostate cancer. PATIENTS AND METHODS: The study included 348 patients who had a RP at one institution, with whole-mount specimens of the prostate examined by one pathologist. Univariate and multivariate analyses were used to assess the relationship of the preoperative PSA level and PSA density with clinical and pathological variables, and by receiver operating characteristic (ROC) analysis to evaluate the relative usefulness of the two factors as predictors for biochemical recurrence. RESULTS: The PSA level before RP was significantly correlated (Spearman's rank correlation) with patient age (P = 0.003), prostate weight (P < 0.001), cancer volume (P < 0.001) and Gleason score (P = 0.033), and with surgical margin status and pathological stage (both P < 0.001) in the RP specimen. In the multivariate analysis controlling for tumour stage, surgical margin status, and Gleason score, both PSA level and PSA density were significant predictors of PSA recurrence (P = 0.027 and 0.01, respectively). ROC analysis showed no statistical difference between the PSA level and PSA density in predicting PSA recurrence after RP (P = 0.40). CONCLUSIONS: These results show a significant correlation of the preoperative PSA level with other established prognostic factors for prostate cancer. In the multivariate analysis, both PSA level and PSA density were independent predictors of PSA recurrence. Because the PSA level is as effective as PSA density in predicting PSA recurrence, the extra effort required to calculate PSA density may not be warranted. We recommend that the PSA level before RP be considered in stratifying patients into different prognostic groups, and in determining the optimum management.

AB - OBJECTIVE: To investigate the relationship of preoperative prostate-specific antigen (PSA) level and PSA density with several clinical and pathological variables, including biochemical recurrence after radical prostatectomy (RP), and to compare the preoperative PSA level and PSA density as prognostic factors in prostate cancer. PATIENTS AND METHODS: The study included 348 patients who had a RP at one institution, with whole-mount specimens of the prostate examined by one pathologist. Univariate and multivariate analyses were used to assess the relationship of the preoperative PSA level and PSA density with clinical and pathological variables, and by receiver operating characteristic (ROC) analysis to evaluate the relative usefulness of the two factors as predictors for biochemical recurrence. RESULTS: The PSA level before RP was significantly correlated (Spearman's rank correlation) with patient age (P = 0.003), prostate weight (P < 0.001), cancer volume (P < 0.001) and Gleason score (P = 0.033), and with surgical margin status and pathological stage (both P < 0.001) in the RP specimen. In the multivariate analysis controlling for tumour stage, surgical margin status, and Gleason score, both PSA level and PSA density were significant predictors of PSA recurrence (P = 0.027 and 0.01, respectively). ROC analysis showed no statistical difference between the PSA level and PSA density in predicting PSA recurrence after RP (P = 0.40). CONCLUSIONS: These results show a significant correlation of the preoperative PSA level with other established prognostic factors for prostate cancer. In the multivariate analysis, both PSA level and PSA density were independent predictors of PSA recurrence. Because the PSA level is as effective as PSA density in predicting PSA recurrence, the extra effort required to calculate PSA density may not be warranted. We recommend that the PSA level before RP be considered in stratifying patients into different prognostic groups, and in determining the optimum management.

KW - Biochemical recurrence

KW - Neoplasm

KW - Prognosis

KW - Prostate

KW - PSA

KW - PSA density

KW - Radical prostatectomy

KW - Staging

UR - http://www.scopus.com/inward/record.url?scp=33644996884&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33644996884&partnerID=8YFLogxK

U2 - 10.1111/j.1464-410X.2006.06022.x

DO - 10.1111/j.1464-410X.2006.06022.x

M3 - Article

C2 - 16469012

AN - SCOPUS:33644996884

VL - 97

SP - 480

EP - 484

JO - BJU International

JF - BJU International

SN - 1464-4096

IS - 3

ER -