[High PSA and total prostatectomy: specific and overall 10-year survival].
BACKGROUND
Radical prostatectomy is not currently a recommended treatment modality for patients with preoperative PSA greater than 40 ng/ml.


OBJECTIVE
To evaluate the specific and overall long-term survival of patients operated despite a PSA greater than 40 ng/ml and to describe the adjuvant treatments associated with the surgical procedure.


METHODS
From 1988 to 1998, 32 consecutive patients with a mean age of 65 years (range: 46-73) underwent retropubic radical prostatectomy. The preoperative work-up (abdominopelvic CT scan, bone scintigraphy) were all interpreted as being normal. All patients had lymph node dissection. Progression was defined by PSA greater than or equal to 0.2 ng/ml or the appearance of metastases.


RESULTS
The mean follow-up was 117 months (range: 2-177). Six patients were alive without progression, and five of them had received adjuvant radiotherapy. Twelve patients were alive with biological progression after second- or third-line treatment. Three patients had died from their cancer and 12 had died from another cause. With a mean follow-up of 10 years, the specific survival of patients operated for high PSA was 80% and the overall survival was 56% with a progression-free survival of 18.7%.


CONCLUSIONS
In rigorously selected patients, radical prostatectomy for high PSA possibly associated with adjuvant radiotherapy can achieve satisfactory prostate cancer control at 10 years for almost 20% of N0M0 patients.
Paul
A
A
Service d'urologie-transplantation, CHU Sud d'Amiens, avenue René-Laënnec-Salouël, 80054 Amiens cedex 1, France. paul.alex@hotmail.com
Fourmarier
M
M
Cordonnier
C
C
Petit
J
J
Petit
J
J
Saint
F
F
D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000401:mortality* / Q000628:therapy*; D012189:Retrospective Studies; D016019:Survival Analysis
D017430:Prostate-Specific Antigen