Impact of preoperative serum PSA level from 0 to 10 ng/ml on pathological findings and disease-free survival after radical prostatectomy

BACKGROUND. To determine the impact of various preoperative serum prostate specific antigen (PSA) levels in the range from 0.1 to 10 ng/ml on patholog ical stage and disease-free survival after radical prostatectomy. METHODS. We selected a cohort of 585 patients who underwent radical prostat ectomy between 1991-1996 for clinically localized prostate cancer and prese nted with preoperative serum PSA levels from 0.1 to 10 ng/ml. RESULTS. Pathological organ-confined disease was present in 57.6% of patien ts. The rate of organ-confined disease decreased from an average of 85% for patients with a PSA value <2 ng/ml, to 46.8% for patients with a PSA value >7 ng/ml. We found statistically significant correlations between preopera tive serum PSA level and overall pathological stage (P = 0.001), pathologic ally organ-confined disease (P = 0.001), margin positive rates (P = 0.001), extra prostatic extension (P = 0.001), and seminal vesicle invasion (P = 0 .001). The overall disease-free survival rate was 87%, with a median follow up of 42.4 months. Disease free survival was significantly better for pati ents with PSA up to 4 ng/ml (P = 0.005). CONCLUSIONS. Our data suggests that PSA detection programs should strive to detect prostate cancer in men before the PSA level rises above 7 ng/ml. In addition, since patients with a PSA level <4 ng/ml had better disease-free survival rates than those with a PSA level between 4.1-10 ng/ml, eliminati ng an arbitrary cutoff of 4 ng/ml, may lead to improved disease-free surviv al.