Men with prostate cancer (PCa) who have high PSA levels have good long-term cancer-specific survival following radical prostatectomy (RP), investigators reported at the 20th annual meeting of the Society of Urologic Oncology in Washington, DC.

Jack R. Andrews, MD, and colleagues at Mayo Clinic in Rochester, Minnesota, examined long-term outcomes among 1307 men who underwent RP at their institution and had a preoperative serum PSA level of 20 ng/mL or higher. The investigators divided patients into 2 groups: high PSA (20 to 49 ng/mL, 1051 men) and extremely high PSA (50 ng/mL or higher, 256 men).

At 20 years, the men with high and extremely high PSA levels had rates of biochemical recurrence (defined as 2 post-RP PSA values of 0.2 ng/mL or higher) of 59.6% and 63.2%, respectively, Dr Andrews’ team reported. Rates of systemic progression at 20 years were 19.8% and 28.5%, respectively. The 20-year cancer-specific mortality rates were 12.8% and 20.5%, respectively. None of the between-group differences were statistically significant.

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“Although PSA ≥20 ng/ml conveys high risk disease, long-term cancer-specific survival remains excellent when treated with RP,” Dr Andrews and his colleagues concluded in their study abstract. “Additionally, we did not observe worse oncologic outcomes when comparing patients with PSA between 20-49 ng/mL and ≥ 50 ng/mL. These data support the use of aggressive management in select men presenting with high PSA.”

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Andrews J, Carlson R, Rangel L, et al. Long-term outcomes of radical prostatectomy in men with a preoperative serum prostate specific antigen level ≥ 20 ng/mL. Presented at the 20th annual meeting of the Society of Urologic Oncology held December 4 to 6 in Washington, DC. Poster 92.