title: The role of radical prostatectomy in the management of patients with high-grade prostate cancer and/or locally advanced disease.
abstract: OBJECTIVE
  To analyze the outcome of patients with clinically localized prostate cancer (PCa) treated with radical prostatectomy (RP) in whom high-grade (HGPCa) and/or locally advanced disease (LAPCa) was found at RP specimen and to evaluate the prognostic value of well-known factors in this subset of patients.
  
  
  METHODS
  Biochemical progression-free (bPFS) was determined with the Kaplan-Meier method. The effect of PSA, biopsy Gleason, clinical stage and number of adverse pathological factors was assessed with univariate and multivariate analyses.
  
  
  RESULTS
  After RP, 87 men had HGPCa (20.7%) or LAPCa (56.3%), with 20 (23%) having both criteria. Mean PSA was 15.5 +/- 14.0 ng/mL and mean follow-up 50.5 +/- 42.6 months. The 5-year bPFS for men with PSA < 10 ng/mL and > or = 10 ng/mL was 54.7% and 35.7%, respectively (p = 0.03). Regarding biopsy Gleason, the 5-year bPFS was 49% and 26% for patients with a score < or = 7 and > 7, respectively (p = 0.002). In the multivariate model, the biopsy Gleason score remained independently associated with biochemical progression.
  
  
  CONCLUSIONS
  HGPCa and/or LAPCa confer poor prognosis; however, RP appears to offer acceptable control, particularly when initial PSA is < 10 ng/mL and biopsy Gleason is 7 or less.
authors.affiliation: Departamento de Urología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, DF. frodriguez.covarrubias@gmail.com
authors.forename: Francisco
authors.initials: F
authors.lastname: Rodríguez-Covarrubias
authors.forename: Ricardo A
authors.initials: RA
authors.lastname: Castillejos-Molina
authors.forename: Mariano
authors.initials: M
authors.lastname: Sotomayor
authors.forename: Fernando
authors.initials: F
authors.lastname: Gabilondo
authors.forename: Guillermo
authors.initials: G
authors.lastname: Feria-Bernal
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*