The role of radical prostatectomy in patients with pretreatment prostate-specific antigen ⩾40 ng/mL☆

Objective: To assess the efficacy of radical prostatectomy (RP) in men presenting with markedly elevated prostate-specific antigen (PSA) levels, the records of 17 patients presenting with serum PSA values ⩾40 ng/mL, who underwent RP at Walter Reed Army Medical Center (WRAMC) between 1990 and 1995, were reviewed. Methods: Pathologic and clinical data (staging, Gleason score, recurrences, adjuvant and neo-adjuvant treatment, most recent PSA value, urinary continence, and sexual function) for each patient was examined. The Kaplan-Meier method was used to analyze the disease-free survival (DFS) for PSA and clinical recurrence. Urinary continence and potency were also assessed. Results: With a mean follow-up of 6.21 years (median 5.28 y), all 17 patients are alive. Five patients have no evidence of disease (NED), and 12 are alive with prostate cancer. Fifteen patients have PSA values between 0.1 and 3.0 ng/mL, and two patients have PSA values that have returned to pretreatment levels. Eleven patients received neo-adjuvant and/or adjuvant therapy. Fourteen men (82.3%) are continent and seven (41.1%) are potent. Survival analysis demonstrates a PSA DFS of 52.9% at five years and 26.5% at nine years; while, clinical DFS was 92.3% at five years and 58.0% at nine years. Conclusions: This study suggests a possible surgical role in treating patients presenting with significantly elevated PSA values. While surgery alone is unlikely to cure prostate cancer in these patients, surgery in conjunction with hormonal or radiation therapy may prolong survival with acceptable effects on urinary continence and potency.