The utility of PSAD for predicting pathological stage and biochemical recurrence after radical prostatectomy (RP) has not been well defined. The goal of this study was to investigate whether PSAD yielded an advantage over total PSA in predicting adverse pathologic characteristics and disease recurrence following RP.
Materials and methods
A total of 13,434 men who underwent radical prostatectomy for clinically localized prostate cancer between 1984 and 2006 were included in this study. The study population was stratified by Gleason score (≤ 6, 7, and ≥ 8) and clinical and pathological characteristics of each group were compared. We constructed receiver operating characteristic (ROC) curves and determined the areas under the receiver operating curves (AUC) and c-index to specifically investigate the accuracy of PSA and PSAD for the prediction of pathological stage and biochemical recurrence.
PSAD was better than PSA in predicting EPE (p<0.001) and BCR (p<0.001) in patients with a biopsy Gleason score ≤ 6. In patients with biopsy Gleason scores of 7, PSA was more predictive than PSAD for SV involvement (p<0.001), LN involvement (p=0.017), and BCR (p<0.001). For men with biopsy Gleason scores ≥ 8, there was no statistical difference between PSA and PSAD in prognostic value for pathological or clinical outcomes.
PSAD is highly associated with pathological stage and biochemical free survival following RP. In lower grade prostate cancers, PSAD is significantly more accurate in predicting EPE and BCR compared to total PSA and should be considered when counseling patients on outcomes following RP.