title: Should patients with a pre-operative prostate-specific antigen greater than 15 ng/ml be offered radical prostatectomy?
abstract: BACKGROUND
  Patients with prostate cancer with a pre-operative prostate-specific antigen (PSA) >15 ng/ml who undergo radical retropubic prostatectomy (RRP) generally do not have a good outcome, yet may have organ-confined cancer and should be offered the option of surgery.
  
  
  OBJECTIVE
  To assess the outcome of patients who underwent RRP with a pre-operative PSA >15 ng/ml.
  
  
  METHODS
  Thirty-four patients, mean pre-operative PSA: 25.46 ng/ml (15.03-76.6) and mean Gleason score: 6.4 (5-9) were assessed.
  
  
  RESULTS
  Two groups were identified. Group I: 41% (14/34) have no biochemical recurrence to mean follow up of 58 months (30-106). Mean PSA: 18.8 ng/ml (15.03-25.84). Mean Gleason score: 6.1 (5-7). Clinical stage: T1c in 80%. No patient had seminal vesicle or lymph node involvement. Group II: 59% (20/34) have biochemical recurrence or died (3) from their disease to mean follow up of 66 months (36-98). Mean PSA: 28.9 ng/ml (15.28-76.6). Mean Gleason score: 6.7 (5-9). Clinical stage: T1c in 25%. Eleven patients had seminal vesicle (8) involvement or positive lymph nodes (3) or both (2).
  
  
  CONCLUSIONS
  RRP seems feasible in patients whose pre-operative PSA is between 15 and 25 ng/ml with stage T1c, Gleason score < or = 7 and negative lymph node frozen section.
authors.affiliation: Department of Urology, St Vincent's University Hospital, Dublin, Ireland.
authors.forename: M F
authors.initials: MF
authors.lastname: O'Brien
authors.forename: S S
authors.initials: SS
authors.lastname: Connolly
authors.forename: D G
authors.initials: DG
authors.lastname: Kelly
authors.forename: A
authors.initials: A
authors.lastname: O'Brien
authors.forename: D M
authors.initials: DM
authors.lastname: Quinlan
authors.forename: D W
authors.initials: DW
authors.lastname: Mulvin
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood; D018579:Patient Selection; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology / Q000601:surgery*; D012016:Reference Values; D016896:Treatment Outcome
chemical_list: D017430:Prostate-Specific Antigen
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