Differences Between Patients with and without Persistent PSA after Radical Prostatectomy in Clinically High-risk and/or Locally Advanced Prostate Cancer

Objective: This study aimed to identify preoperative and postoperative factors associated with persistent prostate-specific antigen (PSA) following radical prostatectomy (RP) in patients with clinically high-risk and/or locally advanced prostate cancer. Understanding these factors can guide early postoperative management decisions, including adjuvant treatment strategies. Materials and Methods: A retrospective analysis was conducted on 183 patients who underwent RP for locally advanced prostate cancer between 2009 and 2023. Patients were divided into two groups: those with persistent PSA at 1 month postoperatively (group 2, n=43), and those without (group 1, n=140). Preoperative and postoperative variables, including PSA levels, clinical stage, biopsy grade group, tumor volume, and pathological findings, were compared between groups. Results: Patients in group 2 had significantly higher preoperative PSA levels (24.6±19 ng/mL vs. 15±15.5 ng/mL, p<0.001), advanced clinical stage (≥T2B: 52.6% vs. 32.1%, p=0.032), and higher percentage of positive biopsy cores (p=0.011). Postoperative findings demonstrated a higher tumor volume (20.2±14.1 cc vs. 10.7±10.5 cc, p=0.002), tumor density (p=0.005), and positive surgical margins (86% vs. 70%, p=0.025) in group 2. Patients in group 2 had higher rates of lymph node dissection, adjuvant therapy, and early salvage radiotherapy. Conclusion: Preoperative PSA levels, biopsy grade group, positive surgical margins, and advanced pathological stage are critical predictors of persistent PSA after RP. Early identification of high-risk patients enables personalized management plans, including timely initiation of adjuvant therapies, to improve outcomes. Further prospective studies are needed to refine risk stratification models and personalize treatment strategies.