Pathological Outcome Following Radical Prostatectomy in Men with PSA Greater than 10 and Histologically Favorable-Risk Prostate Cancer.

Active surveillance (AS) is now the preferred treatment of choice in men with a low-risk prostate cancer. Although there is no consensus on patients who are eligible for AS, PSA above 10 is generally excluded.

In an attempt to determine the validity of using PSA cutoff of 10 in counseling men considering AS, we have analyzed a multi-institution database to determine the pathologic outcome in men with PSA greater than 10 but have a histologically favorable-risk prostate cancer.

Prospectively maintained database on men with histologically favorable risk prostate cancer but underwent radical prostatectomy between 2003 and 2015 were queried. The cohort was categorized into three groups based on PSA levels: Low PSA (LP) (<10), Intermediate PSA (IP) (≥10 and <20), and high PSA (HP) (≥20). The associations between PSA group and adverse pathologic and oncologic outcomes were analyzed.

Of 2125 patients, 1327 patients were categorized as having a histologically favorable risk disease. In multivariate analyses, however, the rates of upstaging and upgrading were similar between the IP and LP group. In contrast, the HP group had higher incidences of both upstaging (p=0. 02) and upgrading to ≥4+3 (p=0. 046) compared to the IP group. BCR-free survival rates revealed no pair-wise inter-group differences, except between LP and HP.

Patients with elevation of preoperative PSA levels between 10 and 20 who otherwise had histologically favorable-risk PCa were not at higher risk for having adverse pathologic outcomes when compared to men with PSA < 10.

The Journal of urology. 2015 Nov 19 [Epub ahead of print]

Jiwoong Yu, Young Suk Kwon, Sinae Kim, Christopher Sejong Han, Nicholas Farber, Jongmyung Kim, Seok Soo Byun, Wun-Jae Kim, Seong Soo Jeon, Isaac Yi Kim

Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA. , Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA; Department of Biostatistics, Rutgers School of Public Health, Piscataway, New Jersey, USA. , Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA; Department of Biostatistics, Rutgers School of Public Health, Piscataway, New Jersey, USA. , Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA. , Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA. , Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA. , Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea. , Department of Urology, Chungbuk National University College of Medicine, Cheongju, Korea. , Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA. 

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