Articles

Prostate Cancer

Pre-operative Percent Free PSA Predicts Clinical Outcomes in Patients Treated with Radical Prostatectomy with Total PSA Levels below 10ng/ml

By: Shahrokh F. Shariatlowast , Khaled F. Abdel-Aziz, Claus G. Roehrborn and Yair Lotan

European Urology, Volume 49 Issue 1, February 2006, Pages 293-302

Published online: 01 February 2006

Keywords: Prostatic neoplasms, Percent free prostate-specific antigen, Progression, Metastasis

Abstract Full Text Full Text PDF (275 KB)

Abstract

Introduction

To evaluate the association of total prostate specific antigen (T-PSA) and percent free PSA (%F-PSA) with prostate cancer outcomes in patients treated with radical prostatectomy (RP).

Methods

Pre-operative serum levels of T-PSA and F-PSA were prospectively measured in 402 consecutive patients treated with RP for clinically localized prostate cancer who had T-PSA levels below 10ng/ml.

Results

T-PSA was not associated with any prostate cancer characteristics or outcomes. Lower %F-PSA was significantly associated with higher percent positive biopsy cores, extracapsular extension, seminal vesicle involvement, lympho-vascular invasion, perineural invasion, positive surgical margins, and higher pathologic Gleason sum. When adjusted for the effects of standard pre-operative features, lower %F-PSA significantly predicted non-organ confined disease, seminal vesicle involvement, lympho-vascular invasion, and biochemical progression. %F-PSA did not retain its association with biochemical progression after adjusting for the effects of standard post-operative features. Based on data from 22 patients with biochemical progression, lower %F-PSA was correlated with shorter T-PSA doubling time after biochemical progression (rho=0.681, p=0.010). %F-PSA was lower in patients who failed salvage radiation therapy (p=0.031) and in patients who developed distant cancer metastases compared to patients who did not (p<0.001).

Conclusions

Pre-operative T-PSA is not associated with prostate cancer outcomes after RP when levels are below 10ng/ml. In contrast, pre-operative %F-PSA is associated with adverse pathologic features, biochemical progression, and features of aggressive disease progression in patients treated with RP and T-PSA levels below 10ng/ml. %F-PSA may improve pre-operative predictive models for predicting clinical outcomes of patients diagnosed with prostate cancer nowadays.

Keywords: Prostatic neoplasms, Percent free prostate-specific antigen, Progression, Metastasis.

Footnotes

Department of Urology, The University of Texas Southwestern Medical Center at Dallas, TX, USA

lowast Corresponding author. Department of Urology, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9110, USA. Tel. +1 214 520 3562; Fax: +1 214 648 8786.

z.star SFS is supported by the Austrian Program for Advanced Research and Technology.

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