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Prostate Cancer
Volume 2014 (2014), Article ID 395078, 6 pages
http://dx.doi.org/10.1155/2014/395078
Research Article

Evaluating the Impact of PSA as a Selection Criteria for Nerve Sparing Radical Prostatectomy in a Screened Cohort

1Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA 02115, USA
2Brigham and Women’s Hospital, 75 Francis Street, ASB1 L2, Boston, MA 02115, USA
3Department of Statistics, University of Connecticut, Storrs, CT 06269, USA
4Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute, Boston, MA 02115, USA
5Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women’s Hospital, Boston, MA 02115, USA

Received 31 January 2014; Revised 18 March 2014; Accepted 19 March 2014; Published 16 April 2014

Academic Editor: Cristina Magi-Galluzzi

Copyright © 2014 Shyam K. Tanguturi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose. We investigated whether NS-RP increased risk of PSA failure and whether PSA should be included as a selection criterion for NS. Methods. We evaluated 357 consecutive men with screen-detected PC who underwent open RP without adjuvant radiotherapy between 9/11/2001 and 12/30/2008. Criteria for NS included Gleason score ≤3 + 4, percentage of positive biopsies (PPB) ≤50%, percentage of core involvement ≤50%, nonapical location, no perineural invasion, and no palpable disease on pre- or intraoperative exam but did not include a PSA threshold. Cox multivariable regression assessed whether increasing PSA or unilateral- or bilateral-NS versus non-NS-RP was associated with PSA failure adjusting for prognostic factors. Results. After a median follow-up of 3.96 years, 34 men sustained PSA failure (9.5%). Increasing PSA was significantly associated with increased risk of PSA failure in the interaction model (adjusted hazard ratio (AHR): 1.09 [95% CI: 1.03–1.16]; ), whereas unilateral (AHR: 1.24 [95% CI: 0.36–4.34]; ) or bilateral NS (AHR: 0.41 [95% CI: 0.06–2.59]; ) versus non-NS RP was not. Conclusion. NS-RP in a screened cohort did not increase risk of PSA failure using NS criteria not including PSA.