Korean J Urol.  2009 Feb;50(2):111-118.

Outcome of Radical Prostatectomy in Prostate Cancer Patients with Prostate-Specific Antigen (PSA) Level Equal to or More Than 20 ng/ml and No Distant Metastasis Preoperatively

• Ham WS
• Kim SW
• Lee JH
• Lee JS
• Choi YD

Abstract

PURPOSE
We assessed the efficacy of radical prostatectomy (RP) in prostate cancer patients with preoperative prostate-specific antigen (PSA) levels > or = 20 ng/ml and no distant metastases.
MATERIALS AND METHODS
The records of 132 prostate cancer patients undergoing RP with preoperative PSA levels > or =20 ng/ml and no distant metastases were reviewed. Sixty-six patients received preoperative neoadjuvant hormonal therapy. Pathologic and clinical outcomes were compared between the groups with PSA of 20-40 ng/ml and > or =40 ng/ml.
RESULTS
There were no statistical differences in age, prostate volume, or the frequency of neoadjuvant hormonal therapy between the two groups. The PSA > or =40 ng/ml group had a higher RP Gleason score, tumor stage, and extracapsular extension. After a mean follow-up of 47.0 months, 73 (55.3%) patients had PSA progression with a median time of 37.0 months. Fifty-six patients received adjuvant hormonal therapy, and 19 received salvage external beam radiation therapy. Clinical disease progression developed in 10 patients (7.6%). During follow-up, 8 patients died, 1 of prostate cancer and 7 of other causes. Preoperative PSA was a significant predictor of PSA progression and time to PSA progression after RP, whereas there were no differences in distant metastasis, local recurrence, hormone-refractory prostate cancer progression, and overall or prostate cancer-specific death between the 2 groups.
CONCLUSIONS
On the basis of the favorable postoperative outcomes of RP in patients with preoperative PSA > or =20 ng/ml and no distant metastases, we suggest that RP has a role in treating these high-risk prostate cancer patients and that preoperative PSA is a significant predictor of postoperative PSA progression.

Keyword

Prostate-specific antigen; Prostatic neoplasms; Prostatectomy; Treatment outcome

MeSH Terms

Disease Progression
Follow-Up Studies
Humans
Neoplasm Grading
Neoplasm Metastasis
Prostate
Prostate-Specific Antigen
Prostatectomy
Prostatic Neoplasms
Recurrence
Treatment Outcome
Prostate-Specific Antigen

Figure

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  Fig. 1 Prostate-specific antigen (PSA) progression-free probability in radical prostatectomy (RP) patients with an initial PSA ≥20 ng/ml. (A) Overall PSA progression-free probability. (B) PSA progression-free probability in the groups with PSA 20-40 ng/ml and ≥40 ng/ml.

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