Should patients with a pre-operative prostate-specific antigen greater than 15 ng/ml be offered radical prostatectomy?
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.
O'Brien
M F
MF
Department of Urology, St Vincent's University Hospital, Dublin, Ireland.
Connolly
S S
SS
Kelly
D G
DG
O'Brien
A
A
Quinlan
D M
DM
Mulvin
D W
DW
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
D017430:Prostate-Specific Antigen
Am J Surg Pathol. 1993 Apr;17(4):336-41
8494103
Cancer. 2002 Jul 15;95(2):281-6
12124827
J Urol. 1994 Nov;152(5 Pt 2):1850-7
7523733
J Urol. 2001 Dec;166(6):2185-8
11696732
J Urol. 1991 May;145(5):998-1002
2016818
JAMA. 1999 May 5;281(17):1591-7
10235151
Urol Clin North Am. 1990 Nov;17(4):689-97
2219572
J Urol. 1996 Oct;156(4):1375-80
8808875
J Urol. 1993 Jul;150(1):110-4
7685418
J Urol. 1998 Aug;160(2):299-315
9679867
Urology. 1995 Sep;46(3 Suppl A):77-82
7653023
J Urol. 1990 Mar;143(3):538-43; discussion 544
2304166
Urol Clin North Am. 1993 Nov;20(4):713-25
7505980
J Urol. 1994 Nov;152(5 Pt 2):1837-42
7523731
Cancer. 1996 Mar 1;77(5):928-33
8608486