Importance of tumor location in patients with high preoperative prostate specific antigen levels (greater than 20 ng/ml) treated with radical prostatectomy.

Academic Article

Abstract

  • PURPOSE: We investigated the effect of tumor location (anterior vs posterior) on pathological characteristics and biochemical-free survival in patients with a preoperative prostate specific antigen level of greater than 20 ng/ml undergoing radical prostatectomy since transition zone tumors are known to present with higher prostate specific antigen levels. MATERIALS AND METHODS: We retrospectively studied the records of 265 patients treated with radical prostatectomy between 1984 and 2005 who had preoperative prostate specific antigen levels greater than 20 ng/ml. Review of pathology reports was performed and tumor location (anterior vs posterior) was defined. Differences in clinicopathological characteristics and prostate specific antigen recurrence rates were examined. RESULTS: Of 265 patients with a preoperative prostate specific antigen level of greater than 20 ng/ml who underwent radical prostatectomy 50 (19%) had anterior tumors and 215 (81%) had posterior tumors. Patients with anterior tumors had lower clinical stage and less seminal vesicle involvement than patients with posterior tumors (p = 0.006 and <0.001, respectively). Although Kaplan-Meier analysis demonstrated significantly higher rates of 5-year biochemical recurrence-free survival for patients with anterior vs posterior tumors (63% vs 40%, p = 0.020), anterior tumor location was not an independent predictor of biochemical recurrence. CONCLUSIONS: Radical prostatectomy is a feasible treatment option in patients with a preoperative prostate specific antigen level of greater than 20 ng/ml. The 5-year biochemical-free survival rate was 47%. Although anterior tumor location was associated with favorable pathological features and improved biochemical-free survival, it was not an independent predictor of biochemical recurrence. Further studies are warranted to identify patients with high preoperative prostate specific antigen levels most likely to have recurrence.
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    Keywords

  • Adenocarcinoma, Adult, Aged, Biomarkers, Tumor, Disease-Free Survival, Humans, Kaplan-Meier Estimate, Lymph Node Excision, Male, Middle Aged, Neoplasm Invasiveness, Neoplasm Recurrence, Local, Neoplasm Staging, Prognosis, Prostate, Prostate-Specific Antigen, Prostatectomy, Prostatic Neoplasms, Retrospective Studies, Seminal Vesicles
  • Digital Object Identifier (doi)

    Author List

  • Magheli A; Rais-Bahrami S; Peck HJ; Walsh PC; Epstein JI; Trock BJ; Gonzalgo ML
  • Start Page

  • 1311
  • End Page

  • 1315
  • Volume

  • 178
  • Issue

  • 4 Pt 1