Radical Prostatectomy as a First-Line Treatment in Patients with Initial PSA >20 ngmL

Abstract EN

Initial PSA >20 ng/mL is generally considered an adverse prognostic feature in prostate cancer (PCa).

Our goals were to estimate the impact of radical prostatectomy (RP) on biochemical recurrence- (BCR-) free and cancer-specific survival (CSS) rates of PCa patients with PSA >20 ng/mL, and to identify patients with favorable oncological outcome.

Using 20 ng/mL as a cut-point value, 205 PCa patients, who underwent RP, were stratified into two groups.

Multivariate analysis was used to determine the significant outcome predictors among patients with PSA >20 ng/mL.

Men in this group had significantly lower 10-yr BCR-free and CSS rates than patients with PSA ≤20 ng/mL (20.7% versus 79.6% (P<0.001) and 65.0% versus 87.9% (P=0.010), resp.).

Pathological stage and lymph node status were found to be the only independent predictors of PSA failure.

Patients with favorable combination of these variables (pT2, N0) had significantly longer 10-yr BCR-free and CSS rates (44.3% versus 0% (P=0.001) and 100.0% versus 33.6% (P=0.011), resp.).

High PSA values do not uniformly indicate poor prognosis after surgery.

Patients, who might benefit the most from RP, are those with organ confined PCa and negative lymph nodes.