It is generally accepted that a complete biochemical response (BR) of a man’s PSA immediately after surgery is an indicator of optimal cancer control. Does this also hold true for men with lymph node invasion (LNI)?

Researchers performed a single institution study of 319 men with prostate cancer and LNI who were treated with surgery (RP) and extended pelvic lymph node dissection (ePLND) between 1998 and 2013. All of the men had complete clinical, pathologic, and follow-up data, including PSA value at 6 weeks after surgery. The men were divided into two groups according to their 6 week PSA value (complete BR (PSA less than 0. 1 ng/ml) and PSA persistence (PSA equal to or greater than 0. 1 ng/ml)).

At eight years post surgery the researchers found that 83 (26%) of the men had PSA persistence. The men with PSA persistence had a higher 8-yr clinical recurrence (CR) and a higher cancer specific mortality rate (CSM) than those with a complete biochemical response (BR).

They also found that a pathologic stage lower than pT3a and Gleason score of 8 or greater, positive surgical margins, and three or more positive lymph nodes were significantly associated with PSA persistence.

The overall results confirmed that early BR can be achieved in approximately 75% of men with LNI submitted to RP and ePLND. PSA assessment early after surgery has an important prognostic role in the prediction of CR and CSM in these node-positive patients. Physicians should perform a risk stratification of men based on PSA persistence to help guide future treatment efforts.

Bear in mind that the risk of clinical recurrence and cancer-specific mortality is heterogeneous in men with prostate cancer, including men with lymph node invasion. Node-positive men with a complete biochemical response early after surgery have a more favorable outcome than those with PSA persistence.

European urology. 2015 Dec 31 [Epub ahead of print]