Vesicourethral anastomosis biopsy after radical prostatectomy: Predictive value of prostate-specific antigen and pathologic stage

Objectives. To assess the role of clinical parameters and pathologic stage in predicting a positive vesicourethral anastomosis (VUA) biopsy in patient s with a rising prostate-specific antigen (PSA) level after radical prostat ectomy. Methods. Forty-five patients were referred for a rising PSA level after rad ical prostatectomy. Transrectal ultrasound evaluation included visualizatio n of the VUA and VUA quadrant biopsies. The rate of positive biopsies (per core and per patient) was correlated with race, PSA level, and the radical prostatectomy pathologic stage. Results. Overall, 53% of patients had a positive biopsy. In multivariate an alysis, the dominant independent and synergistic clinical parameters determ ining positive biopsy rates were a PSA greater than 1 ng/mL at the time of biopsy and the pathologic stage (P = 0.04 and P = 0.02, respectively). Usin g a PSA cutoff point of 1.0 ng/mL, those patients with organ-confined disea se and a PSA of 1.0 ng/mL or less showed no positive cancer cores (low-risk group). Conversely, 89% of patients with extraprostatic extension and a PS A greater than 1.0 ng/mL had a positive biopsy (P <0.01) (high-risk group). Patients with organ-confined disease and a PSA greater than 1.0 ng/mL or e xtraprostatic extension and a PSA 1.0 ng/mL or less (intermediate-risk grou p) had a significantly higher chance of having residual cancer than the low -risk group (P <0.025). Conclusions, The PSA level at the time of biopsy and the pathologic stage o f the radical prostatectomy specimen were the strongest determinants of a p ositive biopsy. A combination of PSA and pathologic stage is useful for dec isions regarding VUA biopsy. Patients with organ-confined disease and a PSA of 1.0 ng/mL or less do not appear to benefit from a VUA biopsy, and patie nts with extraprostatic extension and a PSA greater than 1.0 ng/mL have suc h a high probability (89%) of local recurrence at the VUA that biopsy may b e unnecessary. It appears that VUA biopsy can be restricted to those patien ts with an intermediate risk (organ-confined disease with PSA greater than 1 ng/mL or extraprostatic extension with a PSA less than ng/mL). (C) 1999, Elsevier Science Inc.