Outcome of Antegrade Radical Prostatectomy with Intended Wide Resection in Prostate Cancer Patients with a Preoperative Serum PSA Level >100 ng/ml

Abstract

Objective: It was the aim of this study to assess the outcome of prostate cancer patients with preoperative prostate-specific antigen (PSA) levels ≧100 ng/ml who were treated with antegrade radical prostatectomy with intended wide resection (aRP). Patients and Methods: Eighteen patients who underwent aRP had an initial PSA level ≧100 ng/ml. Overall survival, disease-specific survival and biochemical progression-free survival (bPFS) rates were determined, and predictors of treatment outcome were examined. Results: The median serum PSA level was 159.5 ng/ml. All patients but one had received neoadjuvant androgen deprivation therapy (ADT), while only 2 patients received adjuvant ADT. Five patients were classified as stage pT2, 6 as pT3a, 6 as pT3b and 1 as pT4. Four patients had locoregional lymph node metastases. Twelve patients developed PSA failure. Eight of them received salvage ADT. The estimated 10-year bPFS rate was 25.0% and the overall survival and disease-specific survival rates were 92.9 and 100%, respectively, at a median follow-up of 6 years. Multivariate analysis revealed only the clinical stage to be predictive of bPFS based on preoperative variables. On the other hand, surgical margin status, extracapsular extension and organ-confined disease were identified as being significant postoperative predictors. Conclusions: This study showed a comparatively satisfactory outcome for clinically non-metastatic prostate cancer with PSA levels ≧100 ng/ml treated by aRP.

Present Practice of Thrombosis Prophylaxis of Radical Prostatectomy in a European Country: A Hungarian Multicenter Study

“…Since more than 70% of the procedures were performed by a single surgeon in 93% of the institutes, we were able to draw the conclusion that especially in the high-volume centers the surgeons are experienced enough where most of the patients were treated (62%), which is the most important factor regarding the oncological and functional outcome independent from the preferred approach [11,12]. Experienced centers can even perform RP in selected locally advanced cases with satisfactory results [13]. Good surgeon skills can also decrease blood loss during RP so that the departments can better focus on thrombosis prophylaxis.…”