Importance of Tumor Location in Patients With High Preoperative Prostate Specific Antigen Levels (Greater Than 20 ng/ml) Treated With Radical Prostatectomy

Magheli, Ahmed; Rais-Bahrami, Soroush; Peck, Hugh J.; Walsh, Patrick C.; Epstein, Jonathan I.; Trock, Bruce J.; Gonzalgo, Mark L.

doi:10.1016/j.juro.2007.05.143

« Previous Next »The Journal of Urology
Volume 178, Issue 4 , Pages 1311-1315, October 2007

Importance of Tumor Location in Patients With High Preoperative Prostate Specific Antigen Levels (Greater Than 20 ng/ml) Treated With Radical Prostatectomy

Ahmed Magheli
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland
- Department of Urology, Marienhospital Herne, Herne, Germany
Soroush Rais-Bahrami
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland
Hugh J. Peck
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland
Patrick C. Walsh
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland
Jonathan I. Epstein
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland
- Department of Pathology, The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland
Bruce J. Trock
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland
- Financial interest and/or other relationship with Bristol Myers Squibb.
Mark L. Gonzalgo
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland
- Correspondence: The James Buchanan Urological Institute, The Johns Hopkins Medical Institutions, 600 North Wolfe St., Phipps Building, Suite 560A, Baltimore, Maryland 21287.

Received 5 February 2007 published online 15 August 2007.

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.

Key Words: prostate, prostatic neoplasms, prostate-specific antigen, prostatectomy, neoplasm recurrence, local

Abbreviations and Acronyms: PSA, prostate specific antigen