Persistent Prostate-Specific Antigen After Radical Prostatectomy and Its Impact on Oncologic Outcomes

Background: Persistent prostate-specific antigen (PSA) represents a poor prognostic factor for recurrence after radical prostatectomy (RP). Objective: To investigate the impact of persistent PSA at 6 wk after RP on long-term oncologic outcomes and to assess patient characteristics associated with persistent PSA. Design, setting, and participants: Within a high-volume center database we identified patients who harbored persistent (>= 0.1 ng/ml) versus undetectable PSA (<0.1 ng/ml) at 6 wk after RP. Patients with neo- and/or adjuvant androgen-deprivation therapy (ADT) were excluded. Outcome measurements and statistical analysis: Logistic regression models tested for prediction of persistent PSA. Kaplan-Meier analyses and Cox regression models tested the effect of persistent PSA on metastasis-free survival (MFS), overall survival (OS), and cancer-specific survival (CSS) rates. Propensity score matching (PSM) was performed to test the impact of salvage radiotherapy (SRT) on OS and CSS in patients with persistent PSA. Results and limitations: Of 11 604 identified patients, 8.8% (n = 1025) harbored persistent PSA. At 15 yr after RP, MFS, OS, and CSS were 53.0% versus 93.2% (p < 0.001), 64.7% versus 81.2% (p < 0.001), and 75.5% versus 96.2% (p < 0.001) for persistent versus undetectable PSA, respectively. In multivariable Cox regression models, persistent PSA represented an independent predictor for metastasis (hazard ratio [HR]: 3.59, p < 0.001), death (HR: 1.86, p < 0.001), and cancer-specific death (HR: 3.15, p < 0.001). SRT was associated with improved OS (HR: 0.37, p = 0.02) and CSS (HR: 0.12, p < 0.01) after 1:1 PSM. Main limitation is missing data on postoperative PSA and duration of salvage ADT. Conclusions: Persistent PSA is associated with worse oncologic outcome after RP, namely, metastasis, death, and cancer-specific death. In patients with persistent PSA, SRT resulted in improved OS and CSS. Patient summary: We assessed the impact of persistent prostate-specific antigen (PSA) at 6 wk after radical prostatectomy on oncologic outcomes. Early persistent PSA was associated with worse metastasis-free survival, overall survival, and cancer-specific survival. Salvage radiotherapy may result in a survival benefit in well-selected patients. (C) 2019 Published by Elsevier B.V. on behalf of European Association of Urology.