The Influence Factors Of PSA Failure After Radical Prostatectomy

Purpose：To analyse the clinically related factors of abnormal serum levelof PSA after radical prostatectomy for providing the basis for individualizedfollow-up therapy of patients with prostate cancer.Methods：By using the method of retrospective analysis, analysis theclinical data of72patients with prostate cancer who underwent radicalprostatectomy in the first affiliated hospital and affiliated tumor hospital ofguangxi medical university between January2004to October2013. Observe theeffect of patient’s age, serum total prostate specific antigen, prostatic volume,digital rectal detection, imaging findings, whether neoadjuvant therapy, puncturepathological Gleason score, postoperative Gleason score, clinical stage,pathological stage, lymph node metastasis status and surgical margin statusimpact of the situation on the cutting edge of postoperative PSA values toabnormal PSA after radical prostatectomy. Statistical methods: Two independentsamples were compared using t tests, the percentage or the proportion werecompared using chi-square test,multiple factors analysis using Logistic regression analysis.Results：1.The univariate analysis showed that patient’s age, prostatevolume, digital rectal examination, imaging findings,puncture pathologicalGleason score and clinical stage on postoperative PSA value difference was notstatistically significant (P>0.05).2.Neoadjuvant treatment, the total PSA level,pathologic stage, postoperative Gleason score, lymph node metastasis andmargin status differences in postoperative PSA values were statisticallysignificant (P <0.05).3.The multifactor analysis revealed that postoperativeGleason score, lymph node metastasis states and margin status were independentpredictors of abnormal PSA after radical prostatectomy. Increasing postoperativeGleason score for each level the risk of postoperative abnormal PSA rise2.2times (OR is2.202,95%CI1.026to4.725); The risk of abnormal PSA withlymph node metastasis after surgery is35.3times without lymph nodemetastasis (OR value35.332,95%CI3.45~361.8); The risk of abnormal PSAwith positive surgical margin after surgery was negative margins7.4times (ORvalue of7.401,95%CI1.467~37.333).Conclusions：1.Univariate analysis showed that: Preoperative tPSA,neoadjuvant therapy, postoperative Gleason score, pathologic stage, lymph nodesituation and margin situation are influence factors of abnormal PSA afterradical prostatectomy.2.Multivariate analysis showed that: postoperativeGleason score, lymph node metastasis, margin status were independent factorsof abnormal PSA after radical prostatectomy. GS score≥8, positive lymph nodemetastasis, positive surgical margins, postoperative PSA abnormalities weresignificantly increased.3.When the prostatectomy PSA after radical prostatectomy≥0.2ng/ml, in addition to residual tumor or lymph nodemetastasis factors, the high Gleason score is also a factor of abnormal PSA. Sothat the patients with negative lymph node and negative surgical margin andhigh Gleason score can choose close follow-up or hormonal therapy.