Does a PSA level > 20 ng/ml preclude radical prostatectomy?

There is an interesting report today from an Italian clinical research team on the outcomes of radical prostatectomy in men with higher than normal PSA levels (i.e., 20 ng/ml and higher) at time of diagnosis. We know that all prostate cancer patients with PSA levels > 20 ng/ml are now customarily classified as having high-risk disease.

Gontero et al. carried out a retrospective analysis of data from radical prostatectomy patients  about whom information has been collected in a multi-center, European database. Their objective was to assess the outcomes after radical prostatectomy in a series of patients with high and very high PSA levels.

Based on a careful analysis of the available data, the authors were able to report the following:

  • The database contained 712 radical prostatectomy patients with a baseline PSA level > 20 ng/ml.
  • The patients were categorized into three groups.
    • Group A: Patients with  a preoperative PSA level >100 ng/ml (n = 48)
    • Group B: Patients with a preoperative PSA level between 50.1 and 100 ng/ml (n = 137)
    • Group C: Patients with a preoperative PSA level between 20.1 and 50 ng/ml (n = 527)
  • 10-year projected prostate cancer-specific survival appeared to be significantly affected by the baseline PSA level.
    • 79.8 percent in Group A
    • 85.4 percent in Group B
    • 90.9 percent in Group C
  • 10-year projected overall survival was apparently not significantly affected by the baseline PSA level.
    • 59.6 percent in Group A
    • 71.8 percent in Group B
    • 75.3 percent in Group C
  • At a median follow-up of 78.7 months, rates of biochemical progression-free survival were
    • 6.6 percent in Group A
    • 8.3 percent in Group B
    • 25.8 percent in Group C

The authors conclude that 10-year prostate cancer-specific survival is high — even among men with baseline PSA levels >100 ng/ml, and that radical prostatectomy may be an appropriate treatment option even for some men whose baseline PSA level is >100 ng/ml.

Clearly in making such decisions, other factors would need to be carefully assessed, e.g., Gleason score, clinical stage, patient age, and other health factors. The value of immediate adjuvant therapy (with radiation and/or hormone therapy) in many such patients would also need to be carefully assessed.

One Response

  1. The last paragraph says it all.

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