Radical prostatectomy: an option for high-risk prostate cancer.

Area of Science:

• Urology
• Oncology
• Surgical Oncology

Background:

• High-risk prostate cancer presents significant treatment challenges.
• The efficacy of radical prostatectomy (RP) in patients with very high prostate-specific antigen (PSA) levels remains under investigation.

Purpose of the Study:

• To evaluate the long-term outcomes of open radical retropubic prostatectomy in patients with preoperative PSA ≥ 40 ng/mL.
• To assess survival rates, biochemical recurrence, and quality of life after RP in this high-risk cohort.

Main Methods:

• Retrospective analysis of 56 consecutive patients with PSA ≥ 40 ng/mL undergoing open radical retropubic prostatectomy (1999-2009).
• Kaplan-Meier survival analysis for overall and cancer-specific survival.
• Assessment of biochemical recurrence, quality of life (SF-12), and functional status (pad usage).

Main Results:

• Median follow-up was 83.84 months.
• 84% had locally advanced disease; 46% had positive nodal status.
• 10-year overall survival was 81%, cancer-specific survival was 83%, but biochemical recurrence-free survival was low (11%).
• Favorable quality of life and functional outcomes were reported.

Conclusions:

• Radical prostatectomy in patients with PSA ≥ 40 ng/mL can achieve long-term survival.
• RP facilitates precise adjuvant treatment planning and identifies potentially curable disease.
• While oncological control is achievable, biochemical recurrence rates are notable in this high-risk group.