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Retzius-Sparing Robot-Assisted Radical Prostatectomy
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Is there a prostate-specific antigen upper limit for radical prostatectomy?

Paulo Gontero1, Martin Spahn, Bertrand Tombal

  • 1Department of Urology, University Of Turin, Torino, Italy. paolo.gontero@unito.it

BJU International
|March 12, 2011
PubMed
Summary
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Radical prostatectomy (RP) is feasible for prostate cancer patients with high PSA levels. Even with PSA >100 ng/mL, cancer-specific survival remains high, suggesting RP can be part of treatment.

Area of Science:

  • Urology
  • Oncology
  • Surgical Oncology

Background:

  • Prostate-specific antigen (PSA) levels are crucial in prostate cancer management.
  • Very high PSA levels (>20 ng/mL) often raise concerns about treatment options.
  • Radical prostatectomy (RP) is a primary treatment for localized prostate cancer.

Purpose of the Study:

  • To evaluate the feasibility and outcomes of radical prostatectomy (RP) in prostate cancer patients with very high prostate-specific antigen (PSA) levels.
  • To compare clinical outcomes across different PSA thresholds: 20.1-50 ng/mL, 50.1-100 ng/mL, and >100 ng/mL.

Main Methods:

  • Retrospective analysis of a multicentre European database including 712 RP patients with baseline PSA >20 ng/mL.
  • Patients were categorized into three PSA groups: 20.1-50 ng/mL (n=527), 50.1-100 ng/mL (n=137), and >100 ng/mL (n=48).

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  • Statistical comparisons utilized chi-square tests, ANOVA, and Kaplan-Meier analysis with log-rank tests.

    • Main Results:

    • Ten-year cancer-specific survival was significantly affected by PSA thresholds (79.8% for >100 ng/mL vs. 90.9% for 20.1-50 ng/mL; P=0.037).
    • Overall survival did not show a significant difference across PSA groups (P=0.087).
    • At a median follow-up of 78.7 months, surgical cure rates were 25.8% (20.1-50 ng/mL), 6.6% (50.1-100 ng/mL), and 8.3% (>100 ng/mL).

    Conclusions:

    • Cancer-specific survival, though reduced with higher PSA levels, remains relatively high even for PSA >100 ng/mL.
    • Radical prostatectomy can be a viable option for selected prostate cancer patients with PSA levels exceeding 100 ng/mL.
    • RP may be considered as part of a multimodal treatment strategy for these patients.