loading page

A Nomogram for Predicting Factors of Persistently Elevated Prostate-Specific Antigen in Patients Following Robot-Assisted Radical Prostatectomy
  • +7
  • Uygar Micoogullari,
  • Mehmet Caglar Cakici,
  • Erdem Kısa,
  • Erdem Canda,
  • Furkan Umut Kilic,
  • Arslan Ardicoglu,
  • Serkan Altinova,
  • Ali ATMACA,
  • Ziya Akbulut,
  • Mevlana Derya Balbay
Uygar Micoogullari
Izmir Tepecik Training and Research Hospital
Author Profile
Mehmet Caglar Cakici
Istanbul Medeniyet Universitesi
Author Profile
Erdem Kısa
Izmir Tepecik Training and Research Hospital
Author Profile
Erdem Canda
Koç University
Author Profile
Furkan Umut Kilic
Yildirim Beyazit University Faculty of Medicine
Author Profile
Arslan Ardicoglu
Yildirim Beyazit University Faculty of Medicine
Author Profile
Serkan Altinova
Medicana International Ankara Hospital
Author Profile
Ali ATMACA
Memorial Ankara Hastanesi
Author Profile
Ziya Akbulut
Liv Hospital Ankara
Author Profile
Mevlana Derya Balbay
Koç University
Author Profile

Abstract

Objective:After radical prostatectomy,prostate-specific antigen(PSA) value measuring ≥0.1ng/ml is defined as persistent PSA(pPSA) and in many studies,it was found to be associated with aggressive disease and poor prognosis.Our aim in this study is to point out the pathological and clinical factors affecting pPSA among the patients who underwent robot-assisted radical prostatectomy(RARP) in an experienced academic center and to make a nomogram,predicting pPSA value based on operative data,useful. Methods:We examined records of 1273 patients who underwent RARP retrospectively. Preoperative,operative,and postoperative data were collected.Based on the PSA values (ng/ml) measured after 4-to-8 weeks of RARP,patients were divided into 2 groups as pPSA group (Group1)(n=97) with PSA values ≥0.1ng/ml and undetectable PSA group (Group2)(n=778) with PSA values <0.1ng/ml.Later on,Group1 was further divided into Group1a (PSA:0.1-0.2ng/ml) and Group 1b (PSA≥0.2ng/ml) to evaluate biochemical recurrence(BCR). Results:Multivariate logistic regression analyses of the collected data revealed that PSA>20ng/ml,operation time,a postoperative international society of urological pathology (ISUP) grade of ≥4, pT 3-4, and pN were independently associated with pPSA.According to the results, a nomogram predicting pPSA was developed(Table 4).By looking at the nomogram pPSA was found in 98.9% of the cases with a PSA value of ≥20ng/ml, an operation time of 150 minutes, a postoperative ISUP grade of 4-5, a positive lymphovascular invasion (LVI) status, pT3-T4, and pN+; while pPSA was found in 25.5% of the cases with a PSA value of <20 ng/ml, an operation time of 100 minutes, a postoperative ISUP grade of <4-5, a negative LVI status, pT<3-4, and pN-.The estimated BCR-free survival time was 16.3 months in Group 1a and 57.0 months in Group2 (p<0.001).Adjuvant treatment ratio was 64.9% in Group1 and 7.1% in Group2 (p<0.001). Conclusion:For the patients who underwent RARP,factors associated with aggressive disease can predict the PSA persistence.To plan our treatment modalities accurately,an applicable nomogram in daily practice would be useful.

Peer review status:ACCEPTED

16 Mar 2021Submitted to International Journal of Clinical Practice
18 Mar 2021Submission Checks Completed
18 Mar 2021Assigned to Editor
30 Apr 2021Reviewer(s) Assigned
07 May 2021Review(s) Completed, Editorial Evaluation Pending
11 May 20211st Revision Received
12 May 2021Submission Checks Completed
12 May 2021Assigned to Editor
12 May 2021Review(s) Completed, Editorial Evaluation Pending
24 May 2021Reviewer(s) Assigned
10 Jun 2021Editorial Decision: Accept