Evaluating PSA Density as a Predictor of Biochemical Failure after Radical Prostatectomy: Results of a Prospective Study after a Median Follow-Up of 36 Months

Purpose. To evaluate the predictive ability of PSA density for biochemical relapse after radical prostatectomy in patients operated for clinically localized disease and to compare its predictive strength with preoperative PSA and Gleason score. Patients and Methods. The study evaluated 244 patients with localized disease who underwent an open retropubic radical prostatectomy between February 2007 and April 2011. PSA was measured every 3 months after surgery with a mean follow-up period of 36 months. Two consecutive rises >0.2？ng/mL were considered as biochemical relapse. Results. Biochemical recurrence was observed in 71 (29.1%). A great correlation was found between relapse and PSA ( ), PSA density ( ), Gleason score ( ), pathological stage ( ), positive surgical margins ( ), and invasion of seminal vesicles ( ) and lymph nodes ( ). We also found that PSA density was associated with adverse pathological findings. In univariate and multivariate analysis both PSA ( ) and PSA density ( ) were found to be significant predictors for relapse in contrast to tumor grade. Conclusion. PSA density is a valuable parameter in estimating the danger of biochemical failure and it may increase predictive potential through the incorporation in preoperative nomograms. 1. Introduction The implementation of PSA in the everyday clinical practice has revolutionized prostate cancer screening leading to early detection of the disease and improved survival outcomes [1]. Concomitantly, earlier detection has led to a stage migration and a significant number of the patients who are operated are suffering from low volume even insignificant disease. On the other hand, a great proportion of patients whom the disease is classified preoperatively as organ confined found to have a greater stage and grade prostate cancer, determined after surgical specimen analysis, and such results can influence prognosis and survival [2]. The optimal therapy for localized prostate cancer is still controversial with radical prostatectomy to be the main therapeutic option. The main tools used to estimate the preoperative risk for adverse pathological findings after surgery and the possibility for PSA recurrence after radical treatment are PSA, Gleason score, and clinical stage [3, 4]. However, the rate of biochemical recurrence after surgery is estimated to be around 17% and this rate is reaching 33% in high risk patients [5, 6]. Therefore, improved tools to predict pathological stage and biochemical recurrence are required. Although PSA density has a significant and established role in prostate cancer