BACKGROUND AND OBJECTIVE: 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 patients undergoing salvage RP is unknown. To investigate the impact of persistent PSA after salvage RP on long-term oncologic outcomes. MATERIAL AND METHODS: Patients who underwent salvage RP for recurrent prostate cancer between 2000 and 2021 were identified from twelve 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 on biochemical recurrence (BCR), metastasis and any death after salvage RP. Persistent PSA was defined as a PSA-value ≥ 0.1 ng/ml, at first PSA-measurement after salvage RP. RESULTS: Overall, 580 patients were identified. Of those, 42% (n = 242) harbored persistent PSA. Median follow-up after salvage RP was 38 months, median time to salvage RP was 64 months and median time to first PSA after salvage RP was 2.2 months. At 84 months after salvage RP, BCR-free, metastasis-free, and overall survival was 6.6 vs. 59%, 71 vs. 88% and 77 vs. 94% 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: 5.47, p < 0.001) and death (HR: 3.07, p < 0.01). CONCLUSION: Persistent PSA is common after salvage RP and represents an independent predictor for worse oncologic outcomes. Patients undergoing salvage RP should be closely monitored after surgery to identify those with persistent PSA.

Department of Surgical Sciences San Giovanni Battista Hospital and University of Turin Turin Italy

Department of Urologic Surgery Vanderbilt University Medical Center Nashville TN USA

Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic

Department of Urology Institut Mutualiste Montsouris and Université Paris Descartes Paris France

Department of Urology Koc University Hospital Istanbul Turkey

Department of Urology Ludwig Maximilians University of Munich Munich Germany

Department of Urology Mayo Clinic Rochester MN USA

Department of Urology Medical University of Silesia Zabrze Poland

Department of Urology Medical University of Vienna Vienna Austria

Department of Urology Netherlands Cancer Institute Amsterdam The Netherlands

Department of Urology University Hospital Frankfurt Frankfurt Germany

Department of Urology University Hospital Hamburg Eppendorf Hamburg Germany

Department of Urology University Hospitals Leuven Leuven Belgium

Department of Urology University of Texas Southwestern Dallas TX USA

Department of Urology Weill Cornell Medical College New York NY USA

Hourani Center for Applied Scientific Research Al Ahliyya Amman University Amman Jordan

Keck Medical Center of USC USC Institute of Urology University of Southern California Los Angeles CA USA

Martini Klinik Prostate Cancer Center University Hospital Hamburg Eppendorf Hamburg Germany

Urology Centre Guy's Hospital London UK

World J Urol. 2025 May 9;43(1):288. doi: 10.1007/s00345-025-05586-5. PubMed

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