Prostate Specific Antigen Versus Prostate Specific Antigen Density as a Prognosticator of Pathological Characteristics and Biochemical Recurrence Following Radical Prostatectomy

No AccessJournal of UrologyAdult Urology1 May 2008Prostate Specific Antigen Versus Prostate Specific Antigen Density as a Prognosticator of Pathological Characteristics and Biochemical Recurrence Following Radical Prostatectomy Ahmed Magheli, Soroush Rais-Bahrami, Bruce J. Trock, Elizabeth B. Humphreys, Alan W. Partin, Misop Han, and Mark L. Gonzalgo Ahmed MagheliAhmed Magheli More articles by this author , Soroush Rais-BahramiSoroush Rais-Bahrami More articles by this author , Bruce J. TrockBruce J. Trock More articles by this author , Elizabeth B. HumphreysElizabeth B. Humphreys More articles by this author , Alan W. PartinAlan W. Partin More articles by this author , Misop HanMisop Han More articles by this author , and Mark L. GonzalgoMark L. Gonzalgo More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2008.01.032AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: The usefulness of prostate specific antigen density for predicting pathological stage and biochemical recurrence after radical prostatectomy has not been well defined. We investigated whether prostate specific antigen density yielded an advantage over total prostate specific antigen for predicting adverse pathological characteristics and disease recurrence following radical prostatectomy. 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 or less, 7, and 8 or greater), and the clinical and pathological characteristics of each group were compared. We constructed ROC curves and determined the ROC AUC and concordance index to specifically investigate the accuracy of prostate specific antigen and prostate specific antigen density for predicting pathological stage and biochemical recurrence. Results: Prostate specific antigen density was better than prostate specific antigen for predicting extraprostatic extension and biochemical-free recurrence in patients with a biopsy Gleason score of 6 or less (each p <0.001). In patients with a biopsy Gleason score of 7 prostate specific antigen was more predictive than prostate specific antigen density for seminal vesicle involvement (p <0.001), lymph node involvement (p = 0.017) and biochemical-free recurrence (p <0.001). In men with a biopsy Gleason score of 8 or greater there was no statistical difference between prostate specific antigen and prostate specific antigen density in terms of prognostic value for pathological or clinical outcomes. Conclusions: Prostate specific antigen density is highly associated with pathological stage and biochemical-free survival following radical prostatectomy. In lower grade prostate cancers prostate specific antigen density is significantly more accurate for predicting extraprostatic extension and biochemical-free recurrence compared to total prostate specific antigen. It should be considered when counseling patients on outcomes following radical prostatectomy. References 1 : Prostate-specific antigen corrected for prostate volume improves differentiation of benign prostatic hyperplasia and organ-confined prostatic cancer. Br J Urol1994; 73: 538. Google Scholar 2 : Relationship between prostate specific antigen, prostate volume and age in the benign prostate. Br J Urol1993; 71: 445. 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Google Scholar Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland© 2008 by American Urological AssociationFiguresReferencesRelatedDetailsCited byBusch J, Hamborg K, Meyer H, Buckendahl J, Magheli A, Lein M, Jung K, Miller K and Stephan C (2012) Value of Prostate Specific Antigen Density and Percent Free Prostate Specific Antigen for Prostate Cancer PrognosisJournal of Urology, VOL. 188, NO. 6, (2165-2170), Online publication date: 1-Dec-2012.Magheli A, Hinz S, Hege C, Stephan C, Jung K, Miller K and Lein M (2009) Prostate Specific Antigen Density to Predict Prostate Cancer Upgrading in a Contemporary Radical Prostatectomy Series: A Single Center ExperienceJournal of Urology, VOL. 183, NO. 1, (126-132), Online publication date: 1-Jan-2010.Magheli A and Gonzalgo M (2009) Editorial CommentJournal of Urology, VOL. 182, NO. 5, (2248-2248), Online publication date: 1-Nov-2009. Volume 179Issue 5May 2008Page: 1780-1784 Advertisement Copyright & Permissions© 2008 by American Urological AssociationKeywordsprostateneoplasm recurrence, localprostatectomyprostatic neoplasmsprostate-specific antigenMetricsAuthor Information Ahmed Magheli More articles by this author Soroush Rais-Bahrami More articles by this author Bruce J. Trock More articles by this author Elizabeth B. Humphreys More articles by this author Alan W. Partin More articles by this author Misop Han More articles by this author Mark L. Gonzalgo More articles by this author Expand All Advertisement PDF downloadLoading ...