The role of radical prostatectomy in patients with clinically localized prostate cancer and a prostate-specific antigen level >20 ng/ml

Abstract

Objectives: To determine the outcome of patients with a serum prostate-specific antigen (PSA) level 420 ng/ml that underwent radical prostatectomy (RP). Methods: We retrospectively reviewed the medical records of 147 patients who underwent RP for clinically localized prostate cancer with a pre-treatment PSA (PSApt) 420 ng/ml. Fifty-two patients had positive pelvic lymph nodes and were excluded from analysis. Of 95 patients remaining, 15 were lost to follow-up. Therefore, the study group included 80 patients. The end points for this analysis were biochemical relapse-free survival (bRFS), surgical and post-operative complications and urinary continence. PSApt, pathological grade, surgical margin status, age, clinical stage and immediate androgen ablation were evaluated in a multivariate analysis regarding bRFS. Results: Forty-nine resected specimens (61.2%) were pathologically classified as pT3 or pT4. After a mean follow-up of 64 months, the estimated 5-year bRFS rate was 58% for the overall group. Immediate androgen ablation was the only independent prognostic factor for biochemical relapse (P ¼ 0.001). Concerning the 21 patients who received an immediate androgen ablation after RP, the estimated 5-year bRFS rate was 92%. Complete urinary continence was achieved in 76.5% of patients. Early complications occurred in 13 patients (16.2%). Conclusions: Clinically localized prostate cancer with a PSApt 420 ng/ml is considered as having a poor prognosis. However, RP performed in these patients led to an acceptable morbidity and good functional results. Immediate adjuvant hormonal therapy seems mandatory in this setting to improve bRFS.

Radical Prostatectomy as a First-Line Treatment in Patients with Initial PSA >20 ng/mL

“…As there is paucity in the current literature regarding this specific matter [13, 14, 18], other studies are sorely needed to confirm our results.…”

“…Therefore, many urologists are reluctant to perform RP on patients with PSA values >20 ng/mL [13–15]. …”

“…Some contemporary studies in which patients are diagnosed earlier suggest, however, that the risk may not be so dire [14, 16–21], as some patients, subjected to RP, showed favorable outcomes despite high PSA values [13, 18–23]. …”

Quality of Life Outcome Analysis of Robotic Radical Prostatectomy: A Single Center Experience

“…The least complicated that we could find was NCI criteria currently utilized in post radiation settings [30] and infrequently even in post RP settings. [11,12] We hypothesized that it would offer the related measure outcome in an accurate manner.…”

“…Grade 0 was defined as no incontinence; Grade 1 as incontinence occurring with coughing, sneezing, or laughing; Grade 2 as spontaneous incontinence with some control; and Grade 3 as no control of urine in the absence of any fistula. [11] Postoperative continence was defined when patient had either Grade 0 or Grade 1 continence. [12] Erectile dysfunction (ED) was defined as the persistent inability to achieve and maintain an erection sufficient to permit satisfactory sexual intercourse with or without use of phosphodiesterase (PDE) inhibitor, intracavernosal injection or vacuum erection device.…”