Outcome of radical prostatectomy in prostate cancer patients with prostate-specific antigen (PSA) level equal to more than 20 ng/ml and no distant metastasis preoperatively

Purpose: We assessed the efficacy of radical prostatectomy (RP) in prostate cancer patients with preoperative prostate-specific antigen (PSA) levels ≥ 20 ng/ml and no distant metastases. Materials and Methods: The records of 132 prostate cancer patients undergoing RP with preoperative PSA levels ≥20 ng/ml and no distant metastases were reviewed. Sixty-six patients received preoperative neoadjuvant hormonal therapy. Pathologic and clinical outcomes were compared between the groups with PSA of 20-40 ng/ml and ≥40 ng/ml. Results: There were no statistical differences in age, prostate volume, or the frequency of neoadjuvant hormonal therapy between the two groups. The PSA ≥40 ng/ml group had a higher RP Gleason score, tumor stage, and extracapsular extension. After a mean follow-up of 47.0 months, 73 (55.3%) patients had PSA progression with a median time of 37.0 months. Fifty-six patients received adjuvant hormonal therapy, and 19 received salvage external beam radiation therapy. Clinical disease progression developed in 10 patients (7.6%). During follow-up, 8 patients died, 1 of prostate cancer and 7 of other causes. Preoperative PSA was a significant predictor of PSA progression and time to PSA progression after RP, whereas there were no differences in distant metastasis, local recurrence, hormone-refractory prostate cancer progression, and overall or prostate cancer-specific death between the 2 groups. Conclusions: On the basis of the favorable postoperative outcomes of RP in patients with preoperative PSA ≥20 ng/ml and no distant metastases, we suggest that RP has a role in treating these high-risk prostate cancer patients and that preoperative PSA is a significant predictor of postoperative PSA progression.