[High PSA and total prostatectomy: specific and overall 10-year survival]

Radical prostatectomy is not currently a recommended treatment modality for patients with preoperative PSA greater than 40 ng/ml.

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.

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.

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%.

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.