The role of free to total PSA ratio in prediction of extracapsular tumor extension and biochemical recurrence after radical prostatectomy in patients with PSA between 4 and 10 ng/ml

Int Urol Nephrol. 2012 Aug;44(4):1031-8. doi: 10.1007/s11255-012-0135-y.

Abstract

Objectives: The prognostic value of free to total PSA ratio (F/T PSA) in patients eligible for radical prostatectomy (RP) is controversial. The aim of the present study was to evaluate correlation of F/T PSA with tumor extracapsular extension (ECE) and biochemical recurrence (BR) at long-term follow-up.

Patient and methods: Clinical and pathological data were prospectively gathered from 200 patients treated with RP for clinically localized prostate cancer (PCa) and PSA between 4 and 10 ng/mL. Correlations of preoperative variables including F/T PSA with ECE and BR were evaluated with uni- and multivariate analysis. Adjunctive analyses evaluated the association of PSA F/T with other pathological results. The relationship between preoperative F/T PSA and BR was also assessed with Kaplan–Meier survival analysis.

Results: Lower F/T PSA was significantly correlated with ECE (p = 0.0063), higher GS (p = 0.0054), and seminal vesicles involvement (p = 0.0047). The F/T PSA value of 14% provided the greatest discrimination in predicting ECE. At multivariate analysis, F/T PSA did not achieve the statistical significance for predicting ECE independently. At a mean (median, range) follow-up of 52 (48, 14–116) months, preoperative F/T PSA resulted significantly correlated with BR (p = 0.001). At the Kaplan–Meier survival analysis, the 5-year BR free survival rate resulted 89.3 and 68.9% in the group with F/T PSA >14 and ≤14 ng/mL, respectively (log rank p = 0.0022). At Cox proportional hazard model, only ECE resulted an independent predictor of BR (R = 2.646, p = 0.037).

Conclusion: In patients with clinically localized PCa and PSA 4–10 ng/ml, lower F/T PSA was significantly associated with ECE, other adverse pathologic features, and with BR at the long-term follow-up, but only ECE resulted an independent predictor of BR in our series.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Biopsy, Needle
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Invasiveness
  • Neoplasm Recurrence, Local / blood*
  • Neoplasm Recurrence, Local / pathology
  • Neoplasm Staging
  • Prognosis
  • Prospective Studies
  • Prostate-Specific Antigen / blood*
  • Prostatectomy / methods*
  • Prostatic Neoplasms / blood*
  • Prostatic Neoplasms / pathology
  • Prostatic Neoplasms / surgery

Substances

  • Prostate-Specific Antigen