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 PSA ratio in predicting adverse pathological findings after radical prostatectomy. MATERIALS We analyzed the medical records of 142 patients who underwent a radical prostatectomy from May 2009 until February of 2011. After exclusion of of them for defined criteria, preoperative PSA and its derivatives were analysed for their ability to predict unfavorable pathology after radical prostatectomy. RESULTS From the 105 patients included in the analysis, 23.8% had extraprostatic cancer extension, 8.6% had seminal vesicle involvement and positive surgical margins found in 38.1% of them. PSA density value >0.2 ng/ml2 was the solitary and most significant predictor for 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). Both PSA velocity and ratio failed to reach predictive significance in all analyses. CONCLUSION The present results demonstrate a significance of PSA density in preoperative estimation of adverse pathological findings in patients who undergo radical prostatectomy for clinically localized prostate cancer. A value of 0.2 ng/ml2 seems to be a reliable cutoff. PSA density is a bettgerer predictor than PSA velocity and the PSA ratio.