Introduction: Persistent prostatic specific antigen (PSA) represents a poor prognostic factor for recurrence after radical prostatectomy (RP). However, the impact of persistent PSA on oncologic outcomes in salvage RP patients is unknown. To investigate the impact of persistent PSA after salvage RP on long-term oncologic outcomes. Methods: Patients who underwent salvage RP for recurrent prostate cancer between 2000 and 2021were identified from 11 high-volume centers. Only patients with available PSA after salvage RP were included. Kaplan-Meier analyses and multivariable Cox regression models were used to test the effect of persistent PSA, defined as PSA =0.1ng/ml postoperative on biochemical recurrence (BCR) and death after salvage RP. Results: Overall, 580 patients were identified. Of those, 41.7% (n=242) harbored persistent PSA. Median follow-up was 38 months, median time to salvage RP was 64 months and median time to first PSA after salvage RP was 2.2 months. Patients with persistent PSA had higher median preoperative PSA values (5.8 vs. 4.4 ng/ml, p<0.01), higher proportion of positive margins (40.1 vs. 24.0%, p<0.001), more frequently harbored seminal vesicle invasion (45.9 vs. 24.0%, p<0.001) and lymph node invasion (27.3 vs. 5.9%, p<0.001). At 120 months after salvage RP, BCR-free and overall survival was 6.6 vs. 51.7% and 70.8 vs. 88.2% for patients with persistent vs. undetectable PSA after salvage RP (all p<0.01). In multivariable Cox models persistent PSA was an independent predictor for BCR (HR: 5.6, p<0.001) and death (HR: 3.0, p<0.01). In multivariable logistic regression models higher preoperative PSA (OR: 1.04, p=0.03) and biopsy Gleason 8-10 (OR: 2.24, p<0.01) were independent predictors for PSA persistence after salvage RP. Conclusions: Persistent PSA is common after salvage RP and represents an independent predictor for worse oncologic outcome after salvage RP. Salvage RP patients should be closely monitored after surgery to identify those with persistent PSA. SOURCE OF Funding: None.
.jpg "RehaBaris Incesu, MD (he/him/his) photo")