title: Biochemical disease-free survival in patients with a high prostate-specific antigen level (20-100 ng/mL) and clinically localized prostate cancer after radical prostatectomy.
abstract: OBJECTIVE
  To examine our experience with radical prostatectomy (RP) in patients with a serum prostate-specific antigen (PSA) level of > 20 ng/mL (who are sometimes considered poor candidates for RP) to determine the outcome and possible predictors of a favourable outcome.
  
  
  METHODS
  We retrospectively reviewed the medical records of 79 patients who underwent RP with an initial PSA of 20-100 ng/mL. Biochemical disease-free survival (BDFS) was assessed using the Kaplan-Meier method and predictors of treatment outcome examined by uni- and multivariate analysis. Patients excluded from the analysis were 11 (14%) whose surgery was aborted after finding cancerous pelvic nodes and who did not undergo RP; four others with normal nodes during RP who had metastatic tumour on permanent sections; and 14 who had follow-up data for < 2 years.
  
  
  RESULTS
  The mean (sd) age of the 50 patients in the final study population was 63 (7) years and the mean PSA 37.9 (16.0) ng/mL. The median (range) follow-up was 54 (24-120) months. The BDFS was 60% at 3 years and 48% at 5 years of follow-up. Two patients developed a local recurrence and eight developed metastatic disease. On logistic regression analysis of factors influencing BDFS, only extracapsular extension of disease was predictive of PSA recurrence; no preoperative factor was significant. When time to PSA recurrence was assessed by Cox regression analysis, again only extracapsular extension was predictive, with no preoperative variable a statistically significant predictor.
  
  
  CONCLUSIONS
  Patients with a high serum PSA level (20-100 ng/mL) may be appropriate candidates for RP. While the cancer-free survival is not as good as in patients with a lower PSA, a significant percentage of patients achieve BDFS. No preoperative variables were predictive of disease-free survival or time to PSA recurrence.
authors.affiliation: Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
authors.forename: D W
authors.initials: DW
authors.lastname: Brandli
authors.forename: M O
authors.initials: MO
authors.lastname: Koch
authors.forename: R S
authors.initials: RS
authors.lastname: Foster
authors.forename: R
authors.initials: R
authors.lastname: Bihrle
authors.forename: T A
authors.initials: TA
authors.lastname: Gardner
mesh_terms: D000368:Aged; D001706:Biopsy / Q000379:methods; D018572:Disease-Free Survival; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy / Q000379:methods* / Q000401:mortality; D011471:Prostatic Neoplasms / Q000097:blood / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D016019:Survival Analysis; D020728:Transurethral Resection of Prostate / Q000379:methods
chemical_list: D017430:Prostate-Specific Antigen