Secondary laboratory recurrence after radical prostatectomy: multivariate analysis of clinical, laboratory and histological prognostic factors.

Objectives: To defined the clinical, laboratory and histological variables associated with secondary elevation, after an undetectable phase, of PSA af ter radical prostatectomy. Materials and Methods: this was a prospective study of 83 consecutive patie nts undergoing retropubic radical prostatectomy with an undetectable postop erative criteria (age, total PSA, Gleason score on biopsies, positive apica l biopsies, clinical stage) and four postoperative criteria specimen, posit ive margins, follow-up) for secondary laboratory progression was studied by univariate and multivariate analysis. Results: With a median follow-up of 36 months, the laboratory recurrence ra te was 19%. Laboratory recurrence was associated with a biopsy Gleason scor e greater than or equal to 7 (p=0.04), a high pathological stage (p=0.03), a high histological score (Gleason greater than or equal to 7) (p <0.01) an d positive margins (p=0.04). Logistic regression identified a Gleason score on the operative specimen greater than or equal to 7 to be the only elemen t predictive of secondary laboratory progression. Conclusion: The concept of positive margins or high pathological stage is i nsufficient to identify the risk of laboratory progression after radical pr ostatectomy. The Gleason score, which evaluates tumour aggressiveness, the risk of micrometastases or periprostatic extention, therefore appears to be more useful.