Implications of PSA Kinetics for an Adverse Pathology after Radical Prostatectomy

Objective: To determine and compare the prognostic value of PSA density, PSA velocity and free/total PSAratio in predicting adverse pathological findings after radical prostatectomy. Materials: We analyzed the medicalrecords of 142 patients who underwent a radical prostatectomy from May 2009 until February of 2011. Afterexclusion of of them for defined criteria, preoperative PSA and its derivatives were analysed for their abilityto predict unfavorable pathology after radical prostatectomy.
Results: From the 105 patients included in theanalysis, 23.8% had extraprostatic cancer extension, 8.6% had seminal vesicle involvement and positive surgicalmargins found in 38.1% of them. PSA density value >0.2ng/ml2 was the solitary and most significant predictorfor surgical margin status (p=0.015) and for extracapsular disease (p=0.050) as well, in multivariate analysis.Preoperative PSA was the only significant parameter for seminal vesicle invasion prediction (p=0.033). BothPSA velocity and ratio failed to reach predictive significance in all analyses.
Conclusion: The present resultsdemonstrate a significance of PSA density in preoperative estimation of adverse pathological findings in patientswho undergo radical prostatectomy for clinically localized prostate cancer. A value of 0.2ng/ml2 seems to be areliable cutoff. PSA density is a bettgerer predictor than PSA velocity and the PSA ratio.