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Japanese Journal of Clinical Oncology 33:574-579 (2003)
© 2003 Foundation for Promotion of Cancer Research

Radical Prostatectomy for Prostate Cancer Patients with Prostate-specific Antigen >20 ng/ml

Yen-Chuan Ou1,2, Jung-Ta Chen2,3, Chen-Li Cheng1, Hao-Chung Ho1 and Chi-Rei Yang1,3,+

1 Division of Urology, Department of Surgery and 3 Department of Pathology, Taichung Veterans General Hospital, National Yang-Ming University School of Medicine, Taichung and 2 Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan

Objective: Prostate cancer patients with prostate-specific antigen (PSA) >20 ng/ml are at high risk of progression after radical prostatectomy. Comparison has seldom been made between the outcomes of patients with PSA 20.1–50 ng/ml and those with PSA >50 ng/ml after radical prostatectomy. We retrospectively analyzed the outcomes of these two groups.

Methods: From 1993 to 2002, 60 prostate cancer patients receiving radical prostatectomy were enrolled in this study. Thirty-seven patients with PSA 20.1–50 ng/ml were assigned to Group I. Twenty-three patients with PSA >50 ng/ml were assigned to Group II. Preoperatively, Group II had greater PSA and PSA density than Group I (P < 0.0001). Group II had higher biopsy Gleason score and clinical stage than Group I (P < 0.05). Pathological categories and outcomes of both groups were compared.

Results: Group II had higher Gleason score and tumor volume than Group I (P < 0.05). The incidence of organ-confined diseases was 29.7% in Group I and 0% in Group II (P < 0.05). Group II had higher incidence of extracapsular tumor extension, positive surgical margin and lymph node involvement than Group I (P < 0.05). The incidence of postoperative PSA >0.01 ng/ml and PSA failure were higher in Group II than Group I (P < 0.05). Need for adjuvant treatment and death from prostate cancer was similar in both groups.

Conclusion: Patients with PSA >50 ng/ml had a poorer prognosis than patients with PSA 20.1–50 ng/ml. Those with PSA >50 ng/ml had shorter freedom from PSA failure survivals than those with PSA 20.1–50 ng/ml (P = 0.004). Classification of high-risk prostate patients into two sub-groups with PSA 20.1–50 ng/ml and PSA >50 ng/ml should be considered.

+ For reprints and all correspondence: Chi-Rei Yang, Division of Urology, Department of Surgery, Taichung Veterans General Hospital, 160, Sec. 3, Taichung-Kang Road, 40705 Taichung, Taiwan. E-mail: ycou{at}vghtc.vghtc.gov.tw


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