BACKGROUND:The objective of this study was to assess the surgical and the oncological outcomes in patients with a preoperative prostate specific antigen (PSA) value >20 ng/ml, undergoing robot-assisted radical prostatectomy (RARP) for prostate cancer.
PATIENTS AND METHODS: The records of 2000 men who underwent RARP from February 2006 to April 2010 were retrospectively reviewed. A total of 147 (7.3%) patients with a preoperative PSA value >20 ng/ml were identified. A comparison was performed between the overall patient cohort and the patients with PSA >20 ng/ml. The analyzed parameters included: minor and major postoperative complications, postoperative Gleason score, pathological stage, positive margins and lymph node status, as well as biochemical progression and disease-specific mortality during the follow-up period.
RESULTS: The following results reflect the comparison of the overall cohort of patients vs. the cohort of patients who had a preoperative PSA >20 ng/ml. A statistical difference of the analyzed parameters was observed for median PSA value 10.3 ng/ml vs. 34.8 ng/ml (p< 0.05), for bilateral neurovascular bundle preservation 65.7% vs. 19.7% (p< 0.001), for a Gleason score < 7, 42.8% vs. 12.9% (p< 0.05) and for a Gleason score >7 in 9.5% vs. 19.7% (p< 0.05). Organ-confined disease was noted in 73.5% vs. 31.9% (p< 0.05) and extraprostatic extension in 25.2% vs. 86.1% (p< 0.05). The percentage of cancer found in the prostate specimen was 16.1% vs. 38.1% (p< 0.05) and a positive surgical margin (PSM) status was encountered in 8.9% vs. 33.3% (p< 0.05) of patients. Positive lymph nodes were encountered in 3.2% vs. 17.1% of patients (p< 0.05). After a median follow-up of 19.6 months (range 3-56 months), 118 patients (80.2%) were free of biochemical progression and no disease-specific mortality was evident.
CONCLUSION: Although RARP in patients with preoperative PSA >20 ng/ml is a safe surgical procedure with limited complications, the risk of positive lymph nodes, as well as the PSM status are found to be significantly higher. Patients should be informed of these probable outcomes, as well as for a possible need for adjuvant treatment before undergoing the procedure.
Zugor V, Witt JH, Heidenreich A, Porres D, Labanaris AP. Are you the author?
Department of Urology and Pediatric Urology, St. Antonius Medical Center, Moellenweg 22, 48599 Gronau, Germany.
Reference: Anticancer Res. 2012 May;32(5):2091-5.