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Oncologic outcome after radical prostatectomy in men with PSA values above 20 ng/ml: a monocentric experience

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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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Conflict of interest statement

There is no conflict of interest.

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Authors and Affiliations

  1. Department of Urology of Pitié-Salpétrière Hospital, GHU Est, Assistance-Publique Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, 47-83 bvd de l’Hopital, 75013, Paris, France

    Kien Nguyen, Stephanie Eltz, Sarah J. Drouin, François Audenet, Marc-Olivier Bitker, Emmanuel Chartier-Kastler, François Richard & Morgan Rouprêt

  2. Department of Pathology of Pitié-Salpétrière Hospital, GHU Est, Assistance-Publique Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France

    Eva Comperat

  3. Department of Radiology of Pitié-Salpétrière Hospital, GHU Est, Assistance-Publique Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France

    Raphaele Renard-Penna

  4. CeRePP group “Centre d’Etudes et de Recherche sur les Pathologies Prostatiques”, Paris, France

    Eva Comperat, Olivier Cussenot & Morgan Rouprêt

Authors
  1. Kien Nguyen
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  2. Stephanie Eltz
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  3. Sarah J. Drouin
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  4. Eva Comperat
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  6. Raphaele Renard-Penna
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  7. Marc-Olivier Bitker
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  8. Emmanuel Chartier-Kastler
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  9. François Richard
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  11. Morgan Rouprêt
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Correspondence to Morgan Rouprêt.

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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

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