Radical prostatectomy: Survival outcome and correlation to prostate-specific antigen levels

Background: This paper reviews a 10-year experience with radical retropubic prostatectomy (RP) focussing on survival outcome related to pre- and posto perative levels of prostate-specific antigen (PSA). Patients and Methods: 7 39 patients who underwent RP between 1987 and 1998 were prospectively inves tigated. Kaplan-Meier analyses were performed and correlated to pre- and po stoperative PSA concentrations. Results: In a follow up period of 11 years duration, (mean 3 yrs.) 57 of 739 patients died (20 from prostate disease p rogression, 37 fr om other causes). Correlation between low pre-operative P SA and pathological organ-confinement was significant (p < 0.001). Of 175 p atients with PSA progression, 53 (30%) had never reached undetectable level s of PSA. 57% of PSA relapses were detected during the first year, and 3 % later than 5 yeats post-operatively. Kaplan-Meier analysis yielded an avera ge 3 yeats advantage in estimated prostate-cancer-specific survival when pr e-operative PSA levels were below 50 ng/ml. Overall, prostate-cancer-specif ic and PSA-free 5-year survival-rates were 88%, 96% and 67% respectively. C onclusions: Survival-rates after RP are high even in conjunction with unfav ourable PSA outcome. Merely one third of deaths resulted from prostate canc er, since men at risk frequently suffer from concomitant diseases that affe ct survival.