title: Long-term outcomes of radical prostatectomy with multimodal adjuvant therapy in men with a preoperative serum prostate-specific antigen level > or =50 ng/mL.
abstract: BACKGROUND
  The authors evaluated the long-term outcomes of men with prostate cancer and very high (> or =50 ng/mL) preoperative serum prostate-specific antigen (PSA) values that were treated with radical prostatectomy.
  
  
  METHODS
  This study included 236 men with preoperative serum PSA values > or =50 ng/mL who underwent radical retropubic prostatectomy between 1987 and 2004. For comparison, the study cohort was divided into 2 groups: patients with PSA levels between 50 and 99 ng/mL and patients with PSA levels > or =100 ng/mL. Biochemical recurrence was defined as a single postoperative serum PSA value of 0.4 ng/mL or greater. Systemic disease progression was defined as the development of a local recurrence or systemic metastases, and any death resulting from prostate cancer or its treatment was defined as a cancer-specific mortality.
  
  
  RESULTS
  Biochemical recurrence-free survival rates in the groups of patients with a PSA level 50 to 99 ng/mL and > or =100 ng/mL were 43% and 36% at 10 years, respectively. Systemic progression-free survival rates in the PSA 50 to 99 ng/mL and PSA > or =100 ng/mL groups were 83% and 74% at 10 years, respectively. Estimated overall cancer-specific survival was 87% at 10 years.
  
  
  CONCLUSIONS
  Patients with prostate cancer and a serum PSA level > or =50 ng/mL have very high-risk prostate cancer that carries a high likelihood of being pathologically advanced. Although the probability of realizing long-term survival in these high-risk patients is less than in patients with more favorable disease, 10-year survival outcomes remain excellent and argue for aggressive management of these cases.
authors.affiliation: Department of Urology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
authors.forename: Brant A
authors.initials: BA
authors.lastname: Inman
authors.forename: Judson D
authors.initials: JD
authors.lastname: Davies
authors.forename: Laureano J
authors.initials: LJ
authors.lastname: Rangel
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Bergstralh
authors.forename: Eugene D
authors.initials: ED
authors.lastname: Kwon
authors.forename: Michael L
authors.initials: ML
authors.lastname: Blute
authors.forename: R Jeffrey
authors.initials: RJ
authors.lastname: Karnes
authors.forename: Bradley C
authors.initials: BC
authors.lastname: Leibovich
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D018450:Disease Progression; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000401:mortality* / Q000601:surgery / Q000628:therapy; D015996:Survival Rate
chemical_list: D017430:Prostate-Specific Antigen