title: Outcome of prostate cancer patients with initial PSA> or =20 ng/ml undergoing radical prostatectomy.
abstract: OBJECTIVE
  To retrospectively assess the outcome of patients with initial PSA of 20 ng/ml or higher undergoing radical prostatectomy (RP) for prostate cancer (pCA).
  
  
  METHODS
  Between January 1986 and June 2005, 275 patients with preoperative PSA> or =20 ng/ml underwent RP for pCA at our institution. Overall, disease-specific and biochemical progression-free survival rates for the entire cohort and for particular subgroups were determined.
  
  
  RESULTS
  Median patient age at time of surgery was 64 yr (range: 44-75). Fifty-seven patients (20.7%) had pT2 stage, 206 (74.9%) pT3, and 10 (3.7%) pT4; 78 (28.4%) presented with local nodal metastases (pN+). To date, 40 patients have died (14.5%), 22 of pCA and 18 of other causes. Biochemical progression occurred in 92 patients (33.5%). Overall (and disease-specific) survivals at 5, 10, and 15 yr were 87% (93%), 70% (83%), and 58% (71%), respectively. These survival rates did not significantly differ between patients receiving immediate versus deferred hormonal therapy (in case of progression). Five-year PSA progression-free survival in patients on surveillance (receiving deferred hormonal treatment at the onset of rising PSA values) was 53%. For patients on immediate hormonal treatment following RP, the 5-yr hormone-refractory PSA progression rate was 76%.
  
  
  CONCLUSIONS
  According to long-term follow-up results in this high-risk cohort of patients with preoperative PSA> or =20 ng/ml, RP can be considered a viable therapeutic option. With regard to combining immediate hormonal therapy with surgery, the optimal treatment following RP remains to be defined.
authors.affiliation: Department of Urology and Pediatric Urology, University of Saarland, D-66421 Homburg/Saar, Germany. ulrike.zwergel@uniklinikum-saarland.de
authors.forename: Ulrike
authors.initials: U
authors.lastname: Zwergel
authors.forename: Henrik
authors.initials: H
authors.lastname: Suttmann
authors.forename: Thomas
authors.initials: T
authors.lastname: Schroeder
authors.forename: Stefan
authors.initials: S
authors.lastname: Siemer
authors.forename: Bernd
authors.initials: B
authors.lastname: Wullich
authors.forename: Joern
authors.initials: J
authors.lastname: Kamradt
authors.forename: Jan
authors.initials: J
authors.lastname: Lehmann
authors.forename: Michael
authors.initials: M
authors.lastname: Stoeckle
mesh_terms: D000328:Adult; D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016019:Survival Analysis; D017741:Survivors; D016896:Treatment Outcome
chemical_list: D017430:Prostate-Specific Antigen