Efficacy of Radical Retropubic Prostatectomy as the Primary Treatment for Patients with Clinically Localized Prostate Cancer and a Serum PSA Level ≥0ng/ml

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 ≥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 ≥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 ≥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. (Korean J Urol 2007;48: 945-950)