Is there a prostate-specific antigen upper limit for radical prostatectomy? - Abstract

Department of Urology, University Of Turin, Torino, Italy.

Department of Urology, Julius Maximilians Universität Würzburg, Würzburg, Germany; Department of Urology, Université Catholique De Louvain, Brussels, Belgium; Department of Urology, Community Hospital Karlsruhe, Karlsruhe, Germany; Department of Urology, University Hospitals Leuven, Leuven, Belgium; Department of Urology, University of Piemonte Orientale, Novara, Italy; Department of Urology, University of Udine, Udine, Italy.



Study Type - Prognosis (retrospective cohort) Level of Evidence 2b.

To assess the feasibility of radical prostatectomy (RP) in a series of patients with prostate cancer with very high prostate-specific antigen (PSA) levels by comparing the clinical outcomes of different PSA thresholds (20.1-50 ng/mL, 50.1-100 ng/mL and >100 ng/mL, respectively).

Within a multicentre European retrospective database of 712 RP in patients with a baseline PSA level >20 ng/mL, we identified 48 patients with prostate cancer with a preoperative PSA level >100 ng/mL, 137 with a PSA level between 50.1 and 100 ng/mL and 527 with PSA values between 20.1 and 50 ng/mL. Comparisons between groups were performed using chi-square test, analysis of variance and Kaplan-Meier analysis with log-rank test.

Ten-year projected cancer-specific survival (79.8% in the PSA >100 ng/mL group vs 85.4% in the PSA 50.1-99 ng/mL group vs 90.9% in the PSA 20.1-50 ng/mL interval; P= 0.037) but not overall survival (59.6% in the PSA >100 ng/mL group vs 71.8% in the PSA 50.1-99 ng/mL group vs 75.3% in the PSA 20.1-50 ng/mL interval; P= 0.087) appeared significantly affected by the different PSA thresholds. At a median follow-up of 78.7 months, 25.8%, 6.6% and 8.3% of patients in the PSA level groups for 20.1-50 ng/mL, 50.1-100 ng/mL and >100 ng/mL respectively, were cured by surgery alone.

Ten-year cancer-specific survival, while showing significant reduction with increasing PSA values intervals, remain relatively high even for PSA levels >100 ng/mL. As part of a multimodal treatment strategy, RP may therefore be an option, even in selected patients with prostate cancer whose PSA level is >100 ng/mL.

Written by:
Gontero P, Spahn M, Tombal B, Bader P, Hsu CY, Marchioro G, Frea B, Van Der Eeckt K, Kneitz B, Frohneberg D, Tizzani A, Van Poppel H, Joniau S.   Are you the author?

Reference: BJU Int. 2011 Mar 10. Epub ahead of print.
doi: 10.1111/j.1464-410X.2011.10076.x

PubMed Abstract
PMID: 21392220 Prostate Cancer Section



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