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International Journal of Surgical Oncology
Volume 2012, Article ID 832974, 10 pages
Clinical Study

Radical Prostatectomy as a First-Line Treatment in Patients with Initial PSA  >20 ng/mL

1Clinic of Urology, Department of Surgery, “St. Marina” University Hospital, Hr. Smirnenski Street 1, 9010 Varna, Bulgaria
2Department of Statistics, University of Economics, 9010 Varna, Bulgaria

Received 15 February 2012; Revised 29 May 2012; Accepted 31 May 2012

Academic Editor: Harry J. Wanebo

Copyright © 2012 Alexander I. Hinev et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Initial PSA >20 ng/mL is generally considered an adverse prognostic feature in prostate cancer (PCa). Our goals were to estimate the impact of radical prostatectomy (RP) on biochemical recurrence- (BCR-) free and cancer-specific survival (CSS) rates of PCa patients with PSA >20 ng/mL, and to identify patients with favorable oncological outcome. Using 20 ng/mL as a cut-point value, 205 PCa patients, who underwent RP, were stratified into two groups. Multivariate analysis was used to determine the significant outcome predictors among patients with PSA >20 ng/mL. Men in this group had significantly lower 10-yr BCR-free and CSS rates than patients with PSA ≤20 ng/mL (20.7% versus 79.6% ( ) and 65.0% versus 87.9% ( ), resp.). Pathological stage and lymph node status were found to be the only independent predictors of PSA failure. Patients with favorable combination of these variables (pT2, N0) had significantly longer 10-yr BCR-free and CSS rates (44.3% versus 0% ( ) and 100.0% versus 33.6% ( ), resp.). High PSA values do not uniformly indicate poor prognosis after surgery. Patients, who might benefit the most from RP, are those with organ confined PCa and negative lymph nodes.