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Raised prostate-specific antigen alone may not be a true predictor in high-risk prostate cancer: A retrospective cohort analysis.
- Source :
-
Indian journal of urology : IJU : journal of the Urological Society of India [Indian J Urol] 2022 Jan-Mar; Vol. 38 (1), pp. 22-28. Date of Electronic Publication: 2022 Jan 01. - Publication Year :
- 2022
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Abstract
- Introduction: Prostate-specific antigen (PSA) >20 ng/mL in isolation is a criterion for classification as "high-risk" prostate cancer (PCa). However, among Indian men, PSA elevation is often seen even in the absence of PCa and patients with PSA as the sole criterion for the high-risk disease may have different outcomes from those categorized as high risk due to adverse pathological features. We compared the operative, oncological, and functional outcomes after robot-assisted radical prostatectomy (RARP) in men with high-risk PCa categorized using PSA alone versus clinical and histopathological findings.<br />Materials and Methods: In an Institute Review Board-approved study, men undergoing RARP with high-risk PCa with at least 2-year follow-up were categorized into those with PSA >20 ng/ml being the sole criteria for being high risk (Group A) versus those with Gleason score ≥8 or ≥T2c disease but any PSA level (Group B). The two groups were compared for perioperative, oncological, and functional outcomes.<br />Results: Fifty-three patients with high-risk disease were included. Twenty-six patients (48.9%) were classified into Group A while 27 patients (50.9%) were classified into Group B. The median PSA was significantly higher in Group A (31 [26-35] ng/ml in Group A vs. 21 [12-34] ng/ml in Group B, P = 0.006) and on histopathology of radical prostatectomy specimen, 24 (92.3%) patients had GG ≤3 disease in Group A versus 10 (37%) patients in Group B ( P < 0.001). Patients in both the groups had similar perioperative and continence outcomes. However, Group A had significantly lower biochemical recurrence rate (3/26 [11.5%]) as compared to Group B (11/27 [40.7%]) ( P = 0.012).<br />Conclusions: PSA >20 ng/ml is the single most common criterion for stratification as high-risk PCa. However, men with PSA >20 ng/ml in isolation, without another adverse criterion, have better outcomes than men with adverse clinical or pathological criteria for high-risk disease.<br />Competing Interests: Conflicts of interest: There are no conflicts of interest.<br /> (Copyright: © 2022 Indian Journal of Urology.)
Details
- Language :
- English
- ISSN :
- 0970-1591
- Volume :
- 38
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Indian journal of urology : IJU : journal of the Urological Society of India
- Publication Type :
- Academic Journal
- Accession number :
- 35136291
- Full Text :
- https://doi.org/10.4103/iju.iju_368_21