Preoperative serum prostate specific antigen does not reflect biochemical failure rates after radical prostatectomy in men with large volume cancers

Purpose: We compared pathological findings with prostate specific antigen ( PSA) failure rates following radical prostatectomy for large volume cancers (6 cc or greater). Materials and Methods: A total of 191 men whose radical prostatectomy speci men had a cancer volume of 6 cc or greater were followed for a mean of 3.6 years (range 0.3 to 11.1) and 112 (58.6%) had PSA failure (PSA 0.07 ng./ml. or greater and increasing). Percent Gleason grade 4/5 (the Stanford modifi ed Gleason scale), cancer volume, seminal vesicle invasion, regional lymph nodes, capsular penetration, positive surgical margin, location of the larg est cancer in the peripheral or transition zone, prostate weight, patient a ge, preoperative PSA and clinical stage were analyzed using univariate and multivariate Cox proportional hazards analyses. Results: In univariate regression analysis percent Gleason grade 4/5, lymph node involvement, cancer volume, cancer location in the peripheral zone, c apsular penetration and positive surgical margins were significant predicto rs of biochemical failure. Seminal vesicle invasion, preoperative serum PSA , patient age, prostate weight and clinical stage were not statistically si gnificant. Forward stepwise, multivariate analysis showed that percent Glea son grade 4/5 (p <0.0001, relative risk ratio 2.498), cancer location in th e peripheral zone (p = 0.0097, 1.887), cancer volume (p = 0.0157, 1.691) an d lymph node involvement (p = 0.0317, 1.666) were the only independent pred ictors of biochemical failure. When 52 men with organ confined, large volum e prostate cancer were analyzed separately, univariate and multivariate ana lyses showed that only cancer location in the peripheral zone (p = 0.0021, relative risk ratio 13.473) and percent Gleason grade 4/5 (p = 0.0449, 4.11 1) were independent predictors of failure. Conclusions: Percent Gleason grade 4/5, cancer location in the peripheral z one, cancer volume and lymph node involvement have prognostic value in larg e volume prostate cancer. Cancer location in the peripheral zone and percen t Gleason grade 4/5 are the most powerful predictors of biochemical failure in men whose cancer is 6 cc or greater and contained in the prostatic caps ule. Preoperative serum PSA is not helpful in distinguishing biochemical fa ilure rates in these large volume cancers whether they are organ confined o r not.