Original Article: Clinical Investigation
Prostate-speciﬁc antigen screening impacts on biochemical
recurrence in patients with clinically localized prostate cancer
Takeshi Hashimoto, Makoto Ohori, Kenji Shimodaira, Naoto Kaburaki, Yosuke Hirasawa,
Naoya Satake, Tatsuo Gondo, Yoshihiro Nakagami, Kazunori Namiki and Yoshio Ohno
Department of Urology, Tokyo Medical University, Tokyo, Japan
Abbreviations & Acronyms
BCR = biochemical
BCR-FS = biochemical
CI = conﬁdence interval
HR = hazard ratio
IQR = interquartile range
PLCO = Prostate, Lung,
Colorectal and Ovarian
PRIAS = Prostate Cancer
PSA = prostate-speciﬁc
RARP = robot-assisted
RP = radical prostatectomy
USPSTF = United States
Preventive Services Task
Correspondence: Makoto Ohori
M.D., Department of Urology,
Tokyo Medical University, 6-7-
1 Nishi-shinjuku, Shinjuku-ku,
Tokyo 160-0023, Japan.
Received 24 September 2017;
accepted 9 February 2018.
Online publication 6 April 2018
Objective: To clarify the impact of prostate-speciﬁc antigen screening on surgical
outcomes of prostate cancer.
Methods: Patients who underwent radical prostatectomy were divided into two
groups according to prostate-speciﬁc antigen testing opportunity (group 1, prostate-
speciﬁc antigen screening; group 2, non-prostate-speciﬁc antigen screening).
Perioperative clinical characteristics were compared using the Wilcoxon rank-sum and
-tests. Cox proportional hazards models were used to identify independent predictors
of postoperative biochemical recurrence-free survival.
Results: In total, 798 patients (63.2%) and 464 patients (36.8%) were categorized into
groups 1 and 2, respectively. Group 2 patients were more likely to have a higher
prostate-speciﬁc antigen level and age at diagnosis and larger prostate volume. Clinical
T stage, percentage of positive cores and pathological Gleason score did not differ
between the groups. The 5-year biochemical recurrence-free survival rate was 83.9% for
group 1 and 71.0% for group 2 (P < 0.001). On multivariate analysis, prostate-speciﬁc
antigen testing opportunity (hazard ratio 2.530; P < 0.001) was an independent predictive
factor for biochemical recurrence after surgery, as well as pathological T stage,
pathological Gleason score, positive surgical margin and lymphovascular invasion.
Additional analyses showed that prostate-speciﬁc antigen screening had a greater impact
on biochemical recurrence in a younger patients, patients with a high prostate-speciﬁc
antigen level, large prostate volume and D’Amico high risk, and patients meeting the
exclusion criteria of the Prostate Cancer Research International Active Surveillance study.
Conclusions: Detection by screening results in favorable outcomes after surgery.
Prostate-speciﬁc antigen screening might contribute to reducing biochemical recurrence
in patients with localized prostate cancer.
biochemical recurrence, prostate cancer, prostate-speciﬁc antigen
screening, robot-assisted radical prostatectomy.
The incidence and mortality rates of prostate cancer in Japan are low compared to those in
Some groups have reported that although Japanese men have a lower
risk of prostate cancer, their pathological features reﬂect greater severity than patients in
A study including 108 academic and community practices throughout Japan
found that preoperative serum PSA levels and Gleason scores were higher in a Japanese
cohort compared with those in an American cohort.
Similarly, several previous reports of
Japanese cohorts have reported poorer prognosis after RP compared with North American or
It has been reported that the rate of PSA screening in Japan is much
lower than that in European counties.
Thus, we hypothesized that poorer prognosis after RP
in Japan might be caused by the lower rate of PSA screening. Therefore, the present study
aimed to investigate whether PSA testing opportunity is related to prostate cancer prognosis
in patients who underwent RP.
We retrospectively identiﬁed 1762 patients with localized prostate cancer who underwent
RARP at Tokyo Medical University Hospital between 2006 and 2016. We described
© 2018 The Japanese Urological Association
International Journal of Urology (2018) 25, 561--567 doi: 10.1111/iju.13563