Outcome of prostate cancer patients with initial PSA> or =20 ng/ml undergoing radical prostatectomy.

Authors:
Ulrike Zwergel
Ulrike Zwergel
University of Saarland
Germany
Henrik Suttmann
Henrik Suttmann
Saarland University Hospital
Germany
Thomas Schroeder
Thomas Schroeder
Oncology and Clinical Immunology
Germany
Stefan Siemer
Stefan Siemer
Universitätsklinikum des Saarlandes
Bernd Wullich
Bernd Wullich
University Hospital Erlangen
Germany
Joern Kamradt
Joern Kamradt
University of Saarland
Jan Lehmann
Jan Lehmann
Saarland University
Germany
Michael Stoeckle
Michael Stoeckle
University of Saarland
Germany

Eur Urol 2007 Oct 28;52(4):1058-65. Epub 2007 Mar 28.

Department of Urology and Pediatric Urology, University of Saarland, D-66421 Homburg/Saar, Germany.

Objectives: To retrospectively assess the outcome of patients with initial PSA of 20 ng/ml or higher undergoing radical prostatectomy (RP) for prostate cancer (pCA).

Methods: Between January 1986 and June 2005, 275 patients with preoperative PSA> or =20 ng/ml underwent RP for pCA at our institution. Overall, disease-specific and biochemical progression-free survival rates for the entire cohort and for particular subgroups were determined.

Results: Median patient age at time of surgery was 64 yr (range: 44-75). Fifty-seven patients (20.7%) had pT2 stage, 206 (74.9%) pT3, and 10 (3.7%) pT4; 78 (28.4%) presented with local nodal metastases (pN+). To date, 40 patients have died (14.5%), 22 of pCA and 18 of other causes. Biochemical progression occurred in 92 patients (33.5%). Overall (and disease-specific) survivals at 5, 10, and 15 yr were 87% (93%), 70% (83%), and 58% (71%), respectively. These survival rates did not significantly differ between patients receiving immediate versus deferred hormonal therapy (in case of progression). Five-year PSA progression-free survival in patients on surveillance (receiving deferred hormonal treatment at the onset of rising PSA values) was 53%. For patients on immediate hormonal treatment following RP, the 5-yr hormone-refractory PSA progression rate was 76%.

Conclusions: According to long-term follow-up results in this high-risk cohort of patients with preoperative PSA> or =20 ng/ml, RP can be considered a viable therapeutic option. With regard to combining immediate hormonal therapy with surgery, the optimal treatment following RP remains to be defined.

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http://dx.doi.org/10.1016/j.eururo.2007.03.056DOI Listing
October 2007
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