Characterization and predictors of prostate specific antigen progression rates after radical retropubic prostatectomy

Purpose: Detectable serum prostate specific antigen (PSA) after radical pro statectomy indicates recurrent disease and treatment failure. We characteri zed PSA recurrence after prostatectomy and identified predictors of rapid P SA progression. Materials and Methods: We retrospectively reviewed the medical records of 1 65 patients with detectable PSA after radical prostatectomy to characterize the rate of PSA increase and correlate this rate with the possible predict ors of rapid PSA progression known at prostatectomy. Results: For a median of 48 months postoperatively we followed 142 patients with PSA recurrence after radical prostatectomy who received no immediate adjuvant therapy. PSA doubling time was less than 6, greater than 6, 12, 18 and 24 months in 46%, 54%, 18%, 11% and 9% of cases, while time to PSA 50 ng./ml. was greater than 5, 10, 15 and 20 years in 69%, 34%, 22% and 9%, re spectively. Univariate and multivariate analyses revealed that rapid PSA do ubling time was associated with Gleason secondary grade, Gleason score and time to initial detectable PSA (p = 0.019, 0.031 and 0.0001, and p = 0.043, 0.045 and 0.0001, respectively). Conclusions: PSA recurrence progresses at a greatly variable rate and many recurrences progress slowly with a long doubling time. Gleason secondary gr ade and score appear to be predictive of rapid PSA progression. No other pa thological features were predictive of rapid PSA progression.