Abstract
Objective
To assess the cancer control afforded by radical prostatectomy (RP) in patients with prostate-specific antigen (PSA) values above 20 ng/ml.
Methods
We performed a retrospective review of prostate cancer patients who had initial PSA values above 20 ng/ml and were treated with surgery between 1995 and 2006. Biochemical recurrence was defined as a single rise in PSA levels over 0.2 ng/ml after surgery.
Results
Overall, 41 patients were included. The mean age was 62 ± 6.43 years. The mean PSA was 27.39 ± 13.57 ng/ml (range 20.3–80). After pathological analysis, prostate cancer was organ-confined in 21 cases (51.2%) and locally advanced in 20 cases (48.8%). Positive surgical margins were detected in 36.5% of cases (n = 15). Five patients had lymph node involvement (12%). The mean prostate volume was 58 ± 28.9 cc. The mean length of follow-up after surgery was 94 ± 37 months. Median time to biochemical recurrence was 44.6 ± 22 months. The 5-year PSA-free survival rate was 53%. Through univariate analysis, the pathologic stage (p = 0.016), biopsy and pathological Gleason scores (p = 0.013; p = 0.02) and positive margin (p = 0.04) were associated with recurrence. Overall, 24 patients (58.5%) experienced a biochemical recurrence. Only margin status and pathological Gleason were significant in multivariate analysis (p < 0.05).
Conclusion
RP can be recommended as a viable primary treatment option in selected cases of the high-risk cohort of patients with pre-operative PSA values above 20 ng/ml. However, the modalities of adjuvant treatments following RP remain to be defined in patients who are likely to evolve unfavourably.
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References
Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T et al (2008) Cancer statistics, 2008. CA Cancer J Clin 58:71–96. doi:10.3322/CA.2007.0010
Freedland SJ, Mangold LA, Walsh PC, Partin AW (2005) The prostatic specific antigen era is alive and well: prostatic specific antigen and biochemical progression following radical prostatectomy. J Urol 174:1276–1281. doi:10.1097/01.ju.0000173907.84852.ec
D’Amico AV, Renshaw AA, Cote K, Hurwitz M, Beard C, Loffredo M et al (2004) Impact of the percentage of positive prostate cores on prostate cancer-specific mortality for patients with low or favorable intermediate-risk disease. J Clin Oncol 22:3726–3732. doi:10.1200/JCO.2004.01.164
Partin AW, Kattan MW, Subong EN, Walsh PC, Wojno KJ, Oesterling JE et al (1997) Combination of prostate-specific antigen, clinical stage, and Gleason score to predict pathological stage of localized prostate cancer. A multi-institutional update. JAMA 277:1445–1451. doi:10.1001/jama.277.18.1445
Hull GW, Rabbani F, Abbas F, Wheeler TM, Kattan MW, Scardino PT (2002) Cancer control with radical prostatectomy alone in 1,000 consecutive patients. J Urol 167:528–534. doi:10.1016/S0022-5347(01)69079-7
Boorjian SA, Karnes RJ, Rangel LJ, Bergstralh EJ, Blute ML (2008) Mayo Clinic validation of the D’amico risk group classification for predicting survival following radical prostatectomy. J Urol 179:1354–1360. doi:10.1016/j.juro.2007.11.061
Bastide C, Kuefer R, Loeffler M, de Petriconi R, Gschwend J, Hautmann R (2006) The role of radical prostatectomy in patients with clinically localized prostate cancer and a prostate-specific antigen level > 20 ng/ml. Prostate Cancer Prostatic Dis 9:239–244. doi:10.1038/sj.pcan.4500892
Brandli DW, Koch MO, Foster RS, Bihrle R, Gardner TA (2003) Biochemical disease-free survival in patients with a high prostate-specific antigen level (20–100 ng/mL) and clinically localized prostate cancer after radical prostatectomy. BJU Int 92:19–23. doi:10.1046/j.1464-410X.2003.04269.x
O’Brien MF, Connolly SS, Kelly DG, O’Brien A, Quinlan DM, Mulvin DW (2004) Should patients with a pre-operative prostate-specific antigen greater than 15 ng/ml be offered radical prostatectomy? Ir J Med Sci 173:23–26. doi:10.1007/BF02914519
Frota R, Turna B, Santos BM, Lin YC, Gill IS, Aron M (2008) The effect of prostate weight on the outcomes of laparoscopic radical prostatectomy. BJU Int 101:589–593. doi:10.1111/j.1464-410X.2007.07263.x
Vanasupa BP, Paquette EL, Wu H, Sun L, McLeod DG, Moul JW (2002) The role of radical prostatectomy in patients with pretreatment prostate-specific antigen ≥ 40 ng/mL. Urol Oncol 7:167–172. doi:10.1016/S1078-1439(02)00187-4
Zwergel U, Suttmann H, Schroeder T, Siemer S, Wullich B, Kamradt J et al (2007) Outcome of prostate cancer patients with initial PSA ≥20 ng/ml undergoing radical prostatectomy. Eur Urol 52:1058–1065. doi:10.1016/j.eururo.2007.03.056
Gallina A, Jeldres C, Chun FK, Shariat SF, Briganti A, Walz J et al (2007) Prediction of pathological stage is inaccurate in men with PSA values above 20 ng/mL. Eur Urol 52:1374–1380. doi:10.1016/j.eururo.2006.12.010
Sanda MG, Dunn RL, Michalski J, Sandler HM, Northouse L, Hembroff L et al (2008) Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med 358:1250–1261. doi:10.1056/NEJMoa074311
Bill-Axelson A, Holmberg L, Ruutu M, Haggman M, Andersson SO, Bratell S et al (2005) Radical prostatectomy versus watchful waiting in early prostate cancer. N Engl J Med 352:1977–1984. doi:10.1056/NEJMoa043739
Rozet F, Arroyo C, Cathelineau X, Barret E, Prapotnich D, Vallancien G (2004) Extraperitoneal standard laparoscopic radical prostatectomy. J Endourol 18:605–610. doi:10.1089/end.2004.18.605
Diblasio CJ, Kattan MW (2003) Use of nomograms to predict the risk of disease recurrence after definitive local therapy for prostate cancer. Urology 62(Suppl 1):9–18. doi:10.1016/j.urology.2003.09.029
Stephenson AJ, Scardino PT, Eastham JA, Bianco FJ Jr, Dotan ZA, Fearn PA et al (2006) Preoperative nomogram predicting the 10-year probability of prostate cancer recurrence after radical prostatectomy. J Natl Cancer Inst 98:715–717
Xylinas E, Drouin SJ, Comperat E, Vaessen C, Renard-Penna R, Misrai V et al (2008) Oncological control after radical prostatectomy in men with clinical T3 prostate cancer: a single-centre experience. BJU Int 103:1173–1178. doi:10.1111/j.1464-410X.2008.08208.x
Paul A, Fourmarier M, Cordonnier C, Petit J, Petit J, Saint F (2008) High PSA and total prostatectomy: specific and overall 10-year survival. Prog Urol 18:299–303. doi:10.1016/j.purol.2008.03.016
Bloch BN, Furman-Haran E, Helbich TH, Lenkinski RE, Degani H, Kratzik C et al (2007) Prostate cancer: accurate determination of extracapsular extension with high-spatial-resolution dynamic contrast-enhanced and T2-weighted MR imaging––initial results. Radiology 245:176–185. doi:10.1148/radiol.2451061502
Villers A, Puech P, Mouton D, Leroy X, Ballereau C, Lemaitre L (2006) Dynamic contrast enhanced, pelvic phased array magnetic resonance imaging of localized prostate cancer for predicting tumor volume: correlation with radical prostatectomy findings. J Urol 176:2432–2437. doi:10.1016/j.juro.2006.08.007
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Nguyen, K., Eltz, S., Drouin, S.J. et al. Oncologic outcome after radical prostatectomy in men with PSA values above 20 ng/ml: a monocentric experience. World J Urol 27, 653–658 (2009). https://doi.org/10.1007/s00345-009-0419-8
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DOI: https://doi.org/10.1007/s00345-009-0419-8