Korean J Urol.  2007 Sep;48(9):945-950. 10.4111/kju.2007.48.9.945.

Efficacy of Radical Retropubic Prostatectomy as the Primary Treatment for Patients with Clinically Localized Prostate Cancer and a Serum PSA Level >or=20ng/ml

• Han JH
• Chang IH
• Yu JH
• Han BK
• Jeong SJ
• Hong SK
• Byun SS
• Lee SE

• KMID: 2061296
• DOI: http://doi.org/10.4111/kju.2007.48.9.945

Abstract

PURPOSE
We retrospectively reviewed the clinicopathological characteristics ofpatients who underwent radical retropubic prostatectomy(RRP), and these patients had clinically localized prostate cancer and a preoperative serum prostate-specific antigen(PSA) level >or=20ng/ml.
MATERIALS AND METHODS
Among the 266 patients who underwent RRP without any prior neoadjuvant therapy between March 2004 and March 2006, 29 patients had clinically localized prostate cancer and a preoperative serum PSA level >or=20ng/ml. We analyzed several clinicopathologic factors that might predict organ-confined disease.
RESULTS
Of the 29 patients, 11(37.9%) had organ-confined cancer. The level of serum PSA, the PSA density(PSAD), the Gleason score(3+4 or less), the prostate volume, tumor volume and the tumor percentage were significant factors for predicting organ-confined cancer(p<0.05). The number of the positive cores, the percentage of the core material that was positive, the sum of the tumor length of the positive core, tumor percent of the total core length and tumor percent of the positive core length were also significantly higher in the group with an extraprostatic extension of disease compared tothe organ-confined cancer group(p<0.05).
CONCLUSIONS
For the patients with clinically localized prostate cancer and a serum PSA level >or=20ng/ml, radical prostatectomy can be considered as the primary treatment for some cases that have a relatively lower PSA and PSAD, a biopsy Gleason score of 3+4 or less and low predictive volume of the tumor from the biopsy results.

Keyword

Prostatectomy; Prostate-specific antigen; Biopsy

MeSH Terms

Biopsy
Humans
Neoadjuvant Therapy
Neoplasm Grading
Prostate*
Prostate-Specific Antigen
Prostatectomy*
Prostatic Neoplasms*
Retrospective Studies
Tumor Burden
Prostate-Specific Antigen

Reference

References

1. D'Amico AV, Whittington R, Malkowicz SB, Schultz D, Blank K, Broderick GA, et al. Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA. 1998; 280:969–74.

2. Cooperberg MR, Lubeck DP, Mehta SS, Carroll PR. Time trends in clinical risk stratification for prostate cancer: implications for outcomes (data from CaPSURE). J Urol. 2003; 170:S21–5.

3. Zincke H, Bergstralh EJ, Blute ML, Myers RP, Barrett DM, Lieber MM, et al. Radical prostatectomy for clinically localized prostate cancer: longterm results of 1,143 patients from a single institution. J Clin Oncol. 1994; 12:2254–63.

4. Derweesh IH, Kupelian PA, Zippe C, Levin HS, Brainard J, Magi-Galluzzi C, et al. Continuing trends in pathological stage migration in radical prostatectomy specimens. Urol Oncol. 2004; 22:300–6.

5. Paulson DF, Piserchia PV, Gardner W. Predictors of lymphatic spread in prostatic adenocarcinoma: uro-oncology research group study. J Urol. 1980; 123:697–9.

6. Sogani PC, Israel A, Lieberman PH, Lesser ML, Whitmore WF. Gleason grading of prostate cancer: a predictor of survival. Urology. 1985; 25:223–7.

7. Perrotti M, Rabbani F, Russo P, Solomon MC, Fair WR. Early prostate cancer detection and potential for surgical cure in men with poorly differentiated tumors. Urology. 1998; 52:106–10.

8. Lau WK, Bergstralh EJ, Blute ML, Slezak JM, Zincke H. Radical prostatectomy for pathological Gleason 8 or greater prostate cancer: influence of concomitant pathological variables. J Urol. 2002; 167:117–22.

9. Donohue JF, Bianco FJ, Kuroiwa K, Vickers AJ, Wheeler TM, Scardino PT, et al. Poorly differentiated prostate cancer treated with radical prostatectomy: longterm outcome and incidence of pathological downgrading. J Urol. 2006; 176:991–5.

10. Catalona WJ, Richie JP, Ahmann FR, Hudson MA, Scardino PT, Flanigan RC, et al. Comparison of digital rectal examination and serum prostate specific antigen in the early detection of prostate cancer: results of a multicenter clinical trial of 6,630 men. J Urol. 1994; 151:1283–90.

11. Catalona WJ, Smith DS, Ratliff TL, Basler JW. Detection of organ-confined prostate cancer is increased through prostate-specific antigen-based screening. JAMA. 1993; 270:948–54.

12. Mettlin C, Murphy GP, Lee F, Littrup PJ, Chesley A, Babaian R, et al. Characteristics of prostate cancers detected in a multimodality early detection program. The Investigators of the American Cancer Society-National Prostate Cancer Detection Project. Cancer. 1993; 72:1701–8.

13. Stamey TA, Donaldson AN, Yemoto CE, McNeal JE, Sozen S, Gill H. Histological and clinical findings in 896 consecutive prostates treated only with radical retropubic prostatectomy: epidemiologic significance of annual changes. J Urol. 1998; 160:2412–7.

14. Stephenson RA, Smart CR, Mineau GP, James BC, Janerich DT, Dibble RL. The fall in incidence of prostate carcinoma. On the down side of a prostate specific antigen induced peak in incidence–data from the Utah Cancer Registry. Cancer. 1996; 77:1342–8.

15. Soh S, Kattan MW, Berkman S, Wheeler TM, Scardino PT. Has there been a recent shift in the pathological features and prognosis of patients treated with radical prostatectomy? J Urol. 1997; 157:2212–8.

16. Partin AW, Pound CR, Clemens JQ, Epstein JI, Walsh PC. Serum PSA after anatomic radical prostatectomy. The Johns Hopkins experience after 10 years. Urol Clin North Am. 1993; 20:713–25.

17. Catalona WJ, Smith DS. 5-year tumor recurrence rates after anatomical radical retropubic prostatectomy for prostate cancer. J Urol. 1994; 152:1837–42.

18. Ohori M, Goad JR, Wheeler TM, Eastham JA, Thompson TC, Scardino PT. Can radical prostatectomy alter the progression of poorly differentiated prostate cancer? J Urol. 1994; 152:1843–9.

19. Zincke H, Oesterling JE, Blute ML, Bergstralh EJ, Myers RP, Barrett DM. Long-term (15 years) results after radical prostatectomy for clinically localized (stage T2c or lower) prostate cancer. J Urol. 1994; 152:1850–7.

20. Sokoloff MH, Brendler CB. Indications and contraindications for nerve-sparing radical prostatectomy. Urol Clin North Am. 2001; 28:535–43.

21. Tsuzuki T, Hernandez DJ, Aydin H, Trock B, Walsh PC, Epstein JI. Prediction of extraprostatic extension in the neurovascular bundle based on prostate needle biopsy pathology, serum prostate specific antigen and digital rectal examination. J Urol. 2005; 173:450–3.

22. Ward JF, Slezak JM, Blute ML, Bergstralh EJ, Zincke H. Radical prostatectomy for clinically advanced (cT3) prostate cancer since the advent of prostate-specific antigen testing: 15-year outcome. BJU Int. 2005; 95:751–6.

23. Zwergel U, Suttmann H, Schroeder T, Siemer S, Wullich B, Kamradt J, et al. Outcome of Prostate Cancer Patients with Initial PSA>/=20ng/ml Undergoing Radical Prostatectomy. Eur Urol. 2007 Mar 28. ; [Epub ahead of print].

24. Ward JF, Zincke H. Radical prostatectomy for the patient with locally advanced prostate cancer. Curr Urol Rep. 2003; 4:196–204.

25. Nelson BA, Shappell SB, Chang SS, Wells N, Farnham SB, Smith JA, et al. Tumour volume is an independent predictor of prostate-specific antigen recurrence in patients undergoing radical prostatectomy for clinically localized prostate cancer. BJU Int. 2006; 97:1169–72.

26. Grossklaus DJ, Coffey CS, Shappell SB, Jack GS, Chang SS, Cookson MS. Percent of cancer in the biopsy set predicts pathological findings after prostatectomy. J Urol. 2002; 167:2032–5.

27. Sebo TJ, Bock BJ, Cheville JC, Lohse C, Wollan P, Zincke H. The percent of cores positive for cancer in prostate needle biopsy specimens is strongly predictive of tumor stage and volume at radical prostatectomy. J Urol. 2000; 163:174–8.