Natural history of persistently elevated XXXX after radical prostatectomy: results from the SEARCH database.

@entity1 @entity5 @entity3 @entity204 @entity1486
PURPOSE: We examined natural history, predictors of biochemical recurrence and all cause mortality in @entity1 with persistently elevated @entity1486 after radical prostatectomy in the Shared Equal Access @entity5 Hospital cohort. MATERIALS AND METHODS: We reviewed data on 1,156 @entity1 treated with radical prostatectomy after 1997. @entity1486 persistence was defined as failure to achieve @entity1486 less than 0.03 ng/ml within 6 months postoperatively. Disease-free and overall survival was compared between @entity1 with and without persistence using the log rank test. Predictors of biochemical recurrence and all cause @entity204 were analyzed using the Cox model. RESULTS: A total of 291 @entity1 (25%) had persistence, which was associated with increased biochemical recurrence and all cause @entity204 (p <0.001 and 0.041, respectively). In @entity1 with persistence 1 and 5-year biochemical recurrence-free survival was 68% and 36%, significantly lower than 95% and 72%, respectively, in @entity1 without persistence. Ten-year overall survival in @entity1 with vs without persistence was 63% vs 80%. In @entity1 with persistence independent predictors of @entity1486 recurrence were higher @entity1486 nadir (HR 2.19, p <0.001), positive surgical margins (HR 1.75, p = 0.022) and high pathological Gleason score (8-10 vs 2-6 HR 2.40, p = 0.026). Independent predictors of overall mortality were a higher @entity1486 nadir (HR 1.46, p = 0.013) and @entity3 (HR 3.15, p = 0.047). CONCLUSIONS: @entity1486 persistence is associated with increased biochemical recurrence and overall mortality. In @entity1 with persistence the @entity1486 nadir is an independent predictor of recurrence and mortality. Thus, @entity1486 persistence and nadir are important tools for early postoperative risk stratification.
