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The authors have analyzed the influence of circulating levelsof plasminogen activation inhibitor-1 on the accuracy ofpreoperative and postoperative nomograms for prediction ofprostate cancer recurrence after RP. Preoperative PAI-1 wasindependently associated with BCR. The addition of PAI-1increased the predictive accuracy of the preoperative modelby 1.2%, 7.7%, 10.3%, 6.7% and 5.4% at 1 to 5 years, respec-tively, whereas on the postoperative models the benefitranged from 0.5% to 3.6%.

As is the case with all nomograms, whether improvingthe accuracy by a limited percentage actually directly im-pacts general management remains to be seen, especiallywhen the accuracy of the model is far from 90%. The work isnot strikingly new because the same authors analyzed theusefulness of the plasminogen activation pathway in pros-tate cancer (reference 6 in article). Nevertheless, addinganother potential useful marker is a small brick in the hugewall of cancer behavior prediction.

It remains to be seen whether preoperative predictivevalues of 70% to 78.5%, even if improved compared to theuse of each variable alone, make a real difference for thepatient and treatment on an individual basis. Most likelythey do not, but this should not prevent the urological com-munity from further investigating new biological pathways.

The postoperative prediction of circulating levels of plas-minogen activation inhibitor-1 that and especially the ROCcurves are encouraging. It would have been interesting toknow whether the authors have the data at this stage tosupport that PAI-1 is rather associated with local or distantrecurrence. They obviously have a database and followup ofthese patients, which eventually could influence decisionsregarding adjuvant therapies.

Alexandre R. ZlottaDepartment of Surgery (Urology)

University of TorontoToronto, Canada

PLASMA LEVELS OF PLASMINOGEN ACTIVATION INHIBITOR-1 IN PROSTATE CANCER 1237