Secondary Analysis of PSA and BCR-Free Survival in Asian Prostate Cancer Patients.

Background: Prostate cancer remains a significant global health burden, with biochemical recurrence (BCR) affecting 20-50% of patients post-radical prostatectomy. This study aimed to investigate the relationship between preoperative PSA levels and BCR-free survival in Asian populations. Methods: We conducted a retrospective cohort study of 3,092 prostate cancer patients who underwent radical prostatectomy at Yonsei University College of Medicine, Korea (1992-2014). The exposure variable was preoperative PSA level, and the primary outcome was BCR-free survival. Covariates included age, Gleason score, pathological stage, surgical margins, and other clinical factors. Patients were followed quarterly for two years post-surgery, semi-annually for three years, then annually thereafter (median follow-up: 66 months). Results: Using piecewise linear regression, we identified a significant threshold effect at PSA 5.1 ng/mL. Above this threshold, each unit increase in LnPSA was associated with a 6.10-month reduction in BCR-free survival (95% CI: -7.64 to -4.56, P<0.0001). Higher PSA levels correlated with increased adverse pathological features and shorter BCR-free survival across all risk groups. Conclusion: This study establishes a critical PSA threshold of 5.1 ng/mL for BCR risk stratification in Asian populations. Above this threshold, each unit increase in LnPSA correlates with a 6.10-month reduction in BCR-free survival, providing valuable guidance for post-operative monitoring and personalized treatment strategies.