The incidence and significance of detectable levels of serum prostate specific antigen after radical prostatectomy.

A total of 601 patients who underwent radical retropubic prostatectomy for localized prostate cancer at our institution was followed with serial prostatic specific antigen (PSA) determinations. Three separate groups were delineated by pathological stage: 293 patients with organ confined disease, 215 with involvement of the capsule or positive margins and 93 with extension to the seminal vesicles. Followup ranged from 12 to 237 months (median 34). Five and 10-year disease-free survival rates for the 601 patients were 86 +/- 2% and 78 +/- 3%, respectively. The rate of detectable PSA (greater than 0.4 ng./ml.), used as an indicator of cancer progression, revealed 5 and 10-year disease-free rates of 69 +/- 2% and 47 +/- 3%, respectively. When comparing the patients from an earlier series to those who underwent surgery after 1986, an improvement in the 5-year clinical disease-free rate was noted (78 +/- 2% versus 93 +/- 2%, respectively). Similarly, an improvement in the 5-year disease-free survival rate with nondetectable PSA level was demonstrated in our contemporary series (80 +/- 3%) compared to our historical series. Of the 601 patients 123 had a detectable post-prostatectomy PSA level with or without clinical evidence of metastasis. A PSA doubling time before onset of adjuvant therapy was determined in 94 patients. Post-prostatectomy PSA doubling times were significantly different when comparing the patients who ultimately had progression to distant metastases (median 4.3 months) to those with either clinical local recurrence or a PSA elevation as the sole indicator of recurrence (median 11.7 months). Radical retropubic prostatectomy, whether assessed by clinical or biochemical means, has demonstrated excellent disease-free survival rates, especially since the advent of PSA and anatomical radical prostatectomy.