Abstract

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• INTRODUCTION:

  The optimal management of prostate cancer patients presenting with prostate specific antigen (PSA) levels greater than 50 ng/ml is controversial. The purpose of this study was to investigate factors associated with overall survival and biochemical outcome in a high-risk prostate cancer population with PSA > 50.0 ng/ml at time of diagnosis, and no clinical or radiological evidence of metastatic disease.

  MATERIALS AND METHODS:

  A single institution chart review was conducted at the London Regional Cancer Program on 138 patients who presented with PSA levels greater than 50 ng/ml. Forty-eight (34.8%) of these patients had no clinical or radiological evidence of metastatic disease at time of diagnosis. Patient, tumor, and treatment related variables and biochemical/clinical outcomes were collected for analysis. Median follow-up was 49.4 months. Descriptive and univariable/multivariable analyses were performed in order to assess prognostic factors for freedom from biochemical failure and overall survival.

  RESULTS:

  On univariate analysis, clinical T-stage, Gleason score, primary RT, and PSA measurements including initial PSA, nadir PSA, change in PSA and respective log values were prognostic of biochemical failure. On multivariate analysis, log nadir PSA was prognostic of biochemical failure. No prognostic variables were significant for overall survival in this analysis.

  CONCLUSIONS:

  High-risk prostate cancer patients with PSA > 50 ng/ml and no evidence of metastatic disease have survival characteristics are similar to other high-risk populations reported in the literature, and should be considered for aggressive therapy. The logarithm of the PSA nadir was found to predict for durable biochemical control on multivariable analysis.