Should patients with a pre-operative prostate-specific antigen greater than 15ng/ml be offered radical prostatectomy?

Background Patients with prostate cancer with a pre-operative prostate-specific antigen (PSA) >15 ng/ml who undergo radical retropubic prostatectomy (RRP) generally do not have a good outcome, yet may have organ-confined cancer and should be offered the option of surgery. Aim To assess the outcome of patients who underwent RRP with a pre-operative PSA greater than or equal to15 ng/ml. Methods Thirty-four patients, mean pre-operative PSA: 25.46 ng/ml (15.03-76.6) and mean Gleason score: 6.4 (5-9) were assessed. Results Two groups were identified. Group I: 41% (14/34) have no biochemical recurrence to mean follow up of 58 months (30-106). Mean PSA: 18.8 ng/ml (15.03-25.84). Mean Gleason score: 6.1 (5-7). Clinical stage: T1c in 80%. No patient had seminal vesicle or lymph node involvement. Group II: 59% (20/34) have biochemical recurrence or died (3) from their disease to mean follow up of 66 months (36-98). Mean PSA: 28.9 ng/ml (15.28-76.6). Mean Gleason score: 6.7 (5-9). Clinical stage: T1c in 25%. Eleven patients had seminal vesicle (8) involvement or positive lymph nodes (3) or both (2). Conclusion RRP seems feasible in patients whose pre-operative PSA is between 15 and 25 ng/ml with stage T1c, Gleason score less than or equal to7 and negative lymph node frozen section.