BERKELEY, CA (UroToday.com) - Patients presenting with a PSA >20ng/ml and a diagnosis of prostate cancer (CaP) are often not offered radical prostatectomy (RP) due to the concern over metastasis and likelihood of failure. In the October issue of European Urology, Dr. Zwergel and colleagues from Germany report on a retrospective series of 275 patients with a PSA >20ng/ml who underwent RP. Overall survival (OS) and disease specific survival (DSS) at 15 years was 58% and 71%, suggesting that this is an option for this group of patients.

The 275 patient cohort underwent surgery between 1986 and 2005. Prior to 2000, men received adjuvant androgen deprivation therapy (ADT) for pT3-4 or N+ disease but after the year 2000 men were treated for disease progression only. All men had a negative metastatic evaluation preoperatively.

Median patient age was 64 years and the majority were Gleason score 7 or above. Adjuvant ADT was given to 129 patients. Of the 146 men who underwent surveillance, 36 received delayed ADT. Four patients died in the peri-operative period. At the time of this report, 235 men are still alive with 92(33.5%) having had a biochemical recurrence. Of the 40 patients who died, death was attributed to CaP in 22. Median follow-up was 42 months. OS and DSS at 5, 10, and 15 years were 87% (93%), 70% (83%), and 58% (71%). PSA progression free survival in patient with deferred ADT was 53% at 5 years, compared to 76% for those on immediate ADT. A potential benefit not reported in this study is decreased morbidity secondary to local control of surgery.

Zwergel U, Suttmann H, Schroeder T, Siemer S, Wullich B, Kamradt J, Lehmann J, Stoeckle M

Eur Urol. 52(4): 1058- 1066, October 2007
doi:10.1016/j.eururo.2007.03.056

PubMed Abstract
PMID: 17418938

UroToday.com Prostate Cancer Section

Written by Christopher P. Evans, MD, a Contributing Editor with UroToday.

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