[-2]proPSA Versus Ultrasensitive PSA Fluctuations over Time in the First Year from Radical Prostatectomy, in an High-risk Prostate Cancer Population: A First Report

Overview

Journal BMC Urol

Publisher Biomed Central

Specialty Urology

Date 2016 Mar 26

PMID 27013515

Citations 1

Authors

S De Luca

R Passera

A Sottile

C Fiori

R M Scarpa

F Porpiglia

Affiliations

Soon will be listed here.

Abstract

Background: [-2]proPSA and its derivatives have an higher diagnostic accuracy than PSA in predicting prostate cancer (PCa). In alternative to PSA, ultrasensitive PSA (uPSA) and [-2]proPSA could be potentially useful in recurrent disease detection. This research focused on [-2]proPSA and uPSA fluctuations over time and their possible clinical and pathological determinants, in the first year after RP.

Methods: A cohort of 106 consecutive patients, undergoing RP for high-risk prostate cancer (pT3/pT4 and/or positive margins), was enrolled. No patient received either preoperative/postoperative androgen deprivation therapy or immediate adjuvant RT, this latter for patient choice. [-2]proPSA and uPSA were measured at 1, 3, 6, 9, 12 months after RP; their trends over time were estimated by the mixed-effects linear model. The uPSA relapse was defined either as 3 rising uPSA values after nadir or 2 consecutive uPSA >0.2 ng/ml after RP.

Results: The biochemical recurrence (BCR) rate at 1 year after RP was either 38.6 % (in case of 3 rising uPSA values) or 34.9 % (in case of PSA >0.2 ng/ml after nadir), respectively. The main risk factors for uPSA fluctuations over time were PSA at diagnosis >8 ng/ml (p = 0.014), pT (p = 0.038) and pN staging (p = 0.001). In turn, PSA at diagnosis >8 ng/ml (p = 0.012) and pN (p < 0.001) were the main determinants for [-2]proPSA trend over time. In a 39 patients subgroup, uPSA decreased from month 1 to 3, while [-2]proPSA increased in 90 % of them; subsequently, both uPSA and [-2]proPSA increased in almost all cases. The [-2]proPSA trend over time was independent from BCR status either in the whole cohort as well in the 39 men subgroup.

Conclusions: Both uPSA and [-2]proPSA had independent significant fluctuations over time. PSA at diagnosis >8 ng/ml and pathological staging significantly modified both these trends over time. Since BCR was not confirmed as determinant of [-2]proPSA fluctuations, its use as marker of early biochemical relapse may not be actually recommended, in an high-risk prostate cancer patients population.

Citing Articles

Prognostic and diagnostic value of circRNA expression in prostate cancer: A systematic review and meta-analysis.

Xie J, Jiang H, Zhao Y, Jin X, Li B, Zhu Z Front Oncol. 2022; 12:945143.

PMID: 36419885 PMC: 9676972. DOI: 10.3389/fonc.2022.945143.

References

Lazzeri M, Haese A, De La Taille A, Palou Redorta J, McNicholas T, Lughezzani G . Serum isoform [-2]proPSA derivatives significantly improve prediction of prostate cancer at initial biopsy in a total PSA range of 2-10 ng/ml: a multicentric European study. Eur Urol. 2013; 63(6):986-94. DOI: 10.1016/j.eururo.2013.01.011. View

Ward J, Blute M, Slezak J, Bergstralh E, Zincke H . The long-term clinical impact of biochemical recurrence of prostate cancer 5 or more years after radical prostatectomy. J Urol. 2003; 170(5):1872-6. DOI: 10.1097/01.ju.0000091876.13656.2e. View

Polascik T, Oesterling J, Partin A . Prostate specific antigen: a decade of discovery--what we have learned and where we are going. J Urol. 1999; 162(2):293-306. DOI: 10.1016/s0022-5347(05)68543-6. View

Freedland S, Humphreys E, Mangold L, Eisenberger M, Dorey F, Walsh P . Risk of prostate cancer-specific mortality following biochemical recurrence after radical prostatectomy. JAMA. 2005; 294(4):433-9. DOI: 10.1001/jama.294.4.433. View

Stephan C, Kahrs A, Cammann H, Lein M, Schrader M, Deger S . A [-2]proPSA-based artificial neural network significantly improves differentiation between prostate cancer and benign prostatic diseases. Prostate. 2008; 69(2):198-207. DOI: 10.1002/pros.20872. View

Stephenson A, Scardino P, Kattan M, Pisansky T, Slawin K, Klein E . Predicting the outcome of salvage radiation therapy for recurrent prostate cancer after radical prostatectomy. J Clin Oncol. 2007; 25(15):2035-41. PMC: 2670394. DOI: 10.1200/JCO.2006.08.9607. View

Eggener S, Scardino P, Walsh P, Han M, Partin A, Trock B . Predicting 15-year prostate cancer specific mortality after radical prostatectomy. J Urol. 2011; 185(3):869-75. PMC: 4058776. DOI: 10.1016/j.juro.2010.10.057. View

Le B, Griffin C, Loeb S, Carvalhal G, Kan D, Baumann N . [-2]Proenzyme prostate specific antigen is more accurate than total and free prostate specific antigen in differentiating prostate cancer from benign disease in a prospective prostate cancer screening study. J Urol. 2010; 183(4):1355-9. PMC: 3537165. DOI: 10.1016/j.juro.2009.12.056. View

Porpiglia F, Bertolo R, Manfredi M, De Luca S, Checcucci E, Morra I . Total Anatomical Reconstruction During Robot-assisted Radical Prostatectomy: Implications on Early Recovery of Urinary Continence. Eur Urol. 2015; 69(3):485-95. DOI: 10.1016/j.eururo.2015.08.005. View

10.

Pound C, Partin A, Eisenberger M, Chan D, Pearson J, Walsh P . Natural history of progression after PSA elevation following radical prostatectomy. JAMA. 1999; 281(17):1591-7. DOI: 10.1001/jama.281.17.1591. View

11.

Kang J, Reiter R, Steinberg M, King C . Ultrasensitive prostate specific antigen after prostatectomy reliably identifies patients requiring postoperative radiotherapy. J Urol. 2014; 193(5):1532-8. PMC: 4527538. DOI: 10.1016/j.juro.2014.11.017. View

12.

King C . The timing of salvage radiotherapy after radical prostatectomy: a systematic review. Int J Radiat Oncol Biol Phys. 2012; 84(1):104-11. DOI: 10.1016/j.ijrobp.2011.10.069. View

13.

Moul J . Prostate specific antigen only progression of prostate cancer. J Urol. 2000; 163(6):1632-42. View

14.

Briganti A, Larcher A, Abdollah F, Capitanio U, Gallina A, Suardi N . Updated nomogram predicting lymph node invasion in patients with prostate cancer undergoing extended pelvic lymph node dissection: the essential importance of percentage of positive cores. Eur Urol. 2011; 61(3):480-7. DOI: 10.1016/j.eururo.2011.10.044. View

15.

Epstein J, Allsbrook Jr W, Amin M, Egevad L . The 2005 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma. Am J Surg Pathol. 2005; 29(9):1228-42. DOI: 10.1097/01.pas.0000173646.99337.b1. View

16.

Malik R, Goldberg J, Hochman T, Lepor H . Three-year postoperative ultrasensitive prostate-specific antigen following open radical retropubic prostatectomy is a predictor for delayed biochemical recurrence. Eur Urol. 2011; 60(3):548-53. DOI: 10.1016/j.eururo.2011.05.036. View

17.

Seikkula H, Syvanen K, Kurki S, Mirtti T, Taimen P, Laato M . Role of ultrasensitive prostate-specific antigen in the follow-up of prostate cancer after radical prostatectomy. Urol Oncol. 2014; 33(1):16.e1-16.e7. DOI: 10.1016/j.urolonc.2014.10.010. View

18.

Catalona W, Partin A, Sanda M, Wei J, Klee G, Bangma C . A multicenter study of [-2]pro-prostate specific antigen combined with prostate specific antigen and free prostate specific antigen for prostate cancer detection in the 2.0 to 10.0 ng/ml prostate specific antigen range. J Urol. 2011; 185(5):1650-5. PMC: 3140702. DOI: 10.1016/j.juro.2010.12.032. View

19.

Shimizu F, Tanaka S, Matsuyama Y, Tominaga T, Ohashi Y, Fujime M . Efficiency of ultrasensitive prostate-specific antigen assay in diagnosing biochemical failure after radical prostatectomy. Jpn J Clin Oncol. 2007; 37(6):446-51. DOI: 10.1093/jjco/hym043. View

20.

Hudson M, Bahnson R, Catalona W . Clinical use of prostate specific antigen in patients with prostate cancer. J Urol. 1989; 142(4):1011-7. DOI: 10.1016/s0022-5347(17)38972-3. View