Oncological outcomes in robot-assisted radical prostatectomy: the value of PSA density as a preoperative predictive factor
Background: Pretreatment assessment of patients diagnosed with localized prostate cancer (PCa) is essential for therapeutic decision-making. Currently available staging systems based on prostate-specific antigen (PSA), Gleason score, and clinical stage allow for determining the prognostic characteri...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2024-02-01
|
| Series: | Therapeutic Advances in Urology |
| Online Access: | https://doi.org/10.1177/17562872241229250 |
| _version_ | 1827355531917918208 |
|---|---|
| author | Roser Vives Dilme Juan Gómez Rivas Laura Fernández Hernández Irene De la Parra Sánchez Rafael Sánchez del Hoyo María Isabel Galante Romo Enrique Redondo González José Luis Senovilla Pérez Lorena Fernández Montarroso Jesús Moreno Sierra |
| author_facet | Roser Vives Dilme Juan Gómez Rivas Laura Fernández Hernández Irene De la Parra Sánchez Rafael Sánchez del Hoyo María Isabel Galante Romo Enrique Redondo González José Luis Senovilla Pérez Lorena Fernández Montarroso Jesús Moreno Sierra |
| author_sort | Roser Vives Dilme |
| collection | DOAJ |
| description | Background: Pretreatment assessment of patients diagnosed with localized prostate cancer (PCa) is essential for therapeutic decision-making. Currently available staging systems based on prostate-specific antigen (PSA), Gleason score, and clinical stage allow for determining the prognostic characteristics of these patients. Several studies have evaluated the preoperative use of prostate-specific antigen density (PSAD) as a prognostic factor for further risk stratification. To date, the role of PSAD in this setting is still an object of debate. Objectives: The present analysis aimed to assess the predictive potential of PSAD for adverse oncological outcomes after robot-assisted radical prostatectomy (RARP) and to compare its accuracy to preoperative PSA (pPSA). Design and methods: We retrospectively reviewed 427 patients diagnosed with localized PCa who underwent RARP at a single institution between January 2015 and January 2020. Generating receiver operator characteristic (ROC) curves, calculating areas under the curves (AUCs), and using a linear regression model, we analyzed the association of PSAD and pPSA with postoperative positive surgical margins (PSM), Gleason score ⩾ 7, persistent PSA, and biochemical recurrence (BCR), with a median follow-up of 47 months. Results: PSAD showed a significant association with PSM ( p < 0.0001), PSA persistence ( p < 0.0001), and Gleason ⩾ 7 ( p < 0.0001), without being statistically significant in predicting BCR ( p = 0.098). The predictive value of PSAD was comparable to pPSA for outcomes of PSA persistence (AUC 0.727 versus 0.771) and Gleason ⩾ 7 (AUC 0.683 versus 0.649). Conclusion: PSAD is a predictive factor for postoperative oncological outcomes of PSM, Gleason score ⩾ 7, and persistence of PSA. Despite the need for further studies, PSAD could be useful as a prognostic parameter in conjunction with established staging systems. |
| first_indexed | 2024-03-08T04:44:35Z |
| format | Article |
| id | doaj.art-317ee79e458c4b11bd29aec8ae03e3a8 |
| institution | Directory Open Access Journal |
| issn | 1756-2880 |
| language | English |
| last_indexed | 2024-03-08T04:44:35Z |
| publishDate | 2024-02-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Therapeutic Advances in Urology |
| spelling | doaj.art-317ee79e458c4b11bd29aec8ae03e3a82024-02-08T11:03:39ZengSAGE PublishingTherapeutic Advances in Urology1756-28802024-02-011610.1177/17562872241229250Oncological outcomes in robot-assisted radical prostatectomy: the value of PSA density as a preoperative predictive factorRoser Vives DilmeJuan Gómez RivasLaura Fernández HernándezIrene De la Parra SánchezRafael Sánchez del HoyoMaría Isabel Galante RomoEnrique Redondo GonzálezJosé Luis Senovilla PérezLorena Fernández MontarrosoJesús Moreno SierraBackground: Pretreatment assessment of patients diagnosed with localized prostate cancer (PCa) is essential for therapeutic decision-making. Currently available staging systems based on prostate-specific antigen (PSA), Gleason score, and clinical stage allow for determining the prognostic characteristics of these patients. Several studies have evaluated the preoperative use of prostate-specific antigen density (PSAD) as a prognostic factor for further risk stratification. To date, the role of PSAD in this setting is still an object of debate. Objectives: The present analysis aimed to assess the predictive potential of PSAD for adverse oncological outcomes after robot-assisted radical prostatectomy (RARP) and to compare its accuracy to preoperative PSA (pPSA). Design and methods: We retrospectively reviewed 427 patients diagnosed with localized PCa who underwent RARP at a single institution between January 2015 and January 2020. Generating receiver operator characteristic (ROC) curves, calculating areas under the curves (AUCs), and using a linear regression model, we analyzed the association of PSAD and pPSA with postoperative positive surgical margins (PSM), Gleason score ⩾ 7, persistent PSA, and biochemical recurrence (BCR), with a median follow-up of 47 months. Results: PSAD showed a significant association with PSM ( p < 0.0001), PSA persistence ( p < 0.0001), and Gleason ⩾ 7 ( p < 0.0001), without being statistically significant in predicting BCR ( p = 0.098). The predictive value of PSAD was comparable to pPSA for outcomes of PSA persistence (AUC 0.727 versus 0.771) and Gleason ⩾ 7 (AUC 0.683 versus 0.649). Conclusion: PSAD is a predictive factor for postoperative oncological outcomes of PSM, Gleason score ⩾ 7, and persistence of PSA. Despite the need for further studies, PSAD could be useful as a prognostic parameter in conjunction with established staging systems.https://doi.org/10.1177/17562872241229250 |
| spellingShingle | Roser Vives Dilme Juan Gómez Rivas Laura Fernández Hernández Irene De la Parra Sánchez Rafael Sánchez del Hoyo María Isabel Galante Romo Enrique Redondo González José Luis Senovilla Pérez Lorena Fernández Montarroso Jesús Moreno Sierra Oncological outcomes in robot-assisted radical prostatectomy: the value of PSA density as a preoperative predictive factor Therapeutic Advances in Urology |
| title | Oncological outcomes in robot-assisted radical prostatectomy: the value of PSA density as a preoperative predictive factor |
| title_full | Oncological outcomes in robot-assisted radical prostatectomy: the value of PSA density as a preoperative predictive factor |
| title_fullStr | Oncological outcomes in robot-assisted radical prostatectomy: the value of PSA density as a preoperative predictive factor |
| title_full_unstemmed | Oncological outcomes in robot-assisted radical prostatectomy: the value of PSA density as a preoperative predictive factor |
| title_short | Oncological outcomes in robot-assisted radical prostatectomy: the value of PSA density as a preoperative predictive factor |
| title_sort | oncological outcomes in robot assisted radical prostatectomy the value of psa density as a preoperative predictive factor |
| url | https://doi.org/10.1177/17562872241229250 |
| work_keys_str_mv | AT roservivesdilme oncologicaloutcomesinrobotassistedradicalprostatectomythevalueofpsadensityasapreoperativepredictivefactor AT juangomezrivas oncologicaloutcomesinrobotassistedradicalprostatectomythevalueofpsadensityasapreoperativepredictivefactor AT laurafernandezhernandez oncologicaloutcomesinrobotassistedradicalprostatectomythevalueofpsadensityasapreoperativepredictivefactor AT irenedelaparrasanchez oncologicaloutcomesinrobotassistedradicalprostatectomythevalueofpsadensityasapreoperativepredictivefactor AT rafaelsanchezdelhoyo oncologicaloutcomesinrobotassistedradicalprostatectomythevalueofpsadensityasapreoperativepredictivefactor AT mariaisabelgalanteromo oncologicaloutcomesinrobotassistedradicalprostatectomythevalueofpsadensityasapreoperativepredictivefactor AT enriqueredondogonzalez oncologicaloutcomesinrobotassistedradicalprostatectomythevalueofpsadensityasapreoperativepredictivefactor AT joseluissenovillaperez oncologicaloutcomesinrobotassistedradicalprostatectomythevalueofpsadensityasapreoperativepredictivefactor AT lorenafernandezmontarroso oncologicaloutcomesinrobotassistedradicalprostatectomythevalueofpsadensityasapreoperativepredictivefactor AT jesusmorenosierra oncologicaloutcomesinrobotassistedradicalprostatectomythevalueofpsadensityasapreoperativepredictivefactor |