A MULTIVARIATE-ANALYSIS OF CLINICAL AND PATHOLOGICAL FACTORS THAT PREDICT FOR PROSTATE-SPECIFIC ANTIGEN FAILURE AFTER RADICAL PROSTATECTOMYFOR PROSTATE-CANCER

A Cox regression multivariate analysis was done to determine the clini cal and pathological indicators that predict for prostate specific ant igen (PSA) failure in 347 patients who underwent radical prostatectomy for clinically localized prostate cancer between 1989 and 1993. In th e patient subgroups (PSA less than 20 ng./ml. and biopsy Gleason sum 5 to 7 or PSA more than 10 to 20 ng./ml. and biopsy Gleason sum 2 to 4) not classifiable into those at high and low risk for postoperative PS A failure using PSA and biopsy Gleason sum, the status of the seminal vesicles and prostatic capsule on endo-rectal coil magnetic resonance imaging (MRI) allowed for this categorization. Specifically, 2-year ac tuarial PSA failure rates were 84% versus 23% in patients with and wit hout seminal vesicle invasion, respectively, on MRI (p <0.0001) and 58 % versus 21% in those with and without extracapsular extension, respec tively (p = 0.0001). In patients with extracapsular extension but with out pathological involvement of the seminal vesicle(s) or poorly diffe rentiated tumors (pathological Gleason sum 8 to 10), the 2-year actuar ial PSA failure rates were 50% (margin positive), 28% (margin negative with established extracapsular disease) and 9% (margin negative with focal microscopic extracapsular disease). Therefore, endo-rectal coil MRI showing seminal vesicle invasion or extracapsular extension when t he PSA level is less than 20 ng./ml. and the biopsy Gleason sum is 5 t o 7 or the PSA level is more than 10 but less than 20 ng./ml. and the biopsy Gleason sum is 2 to 4 predicted for PSA failure. In patients wi th extracapsular extension who had pathological Gleason sum less than 8 disease with uninvolved seminal vesicles, the margin status and exte nt of extracapsular disease predicted for PSA failure.