Lower prostate specific antigen outcome than expected following radical prostatectomy in patients with high grade prostate cancer and a prostatic specific antigen level of 4 ng./ml. or less

Purpose: We report the estimates of 10-year prostate specific antigen (PSA) outcome following radical prostatectomy in patients with or without grade 4 or 5 disease in the needle biopsy or prostatectomy specimen stratified by the presenting PSA level. Materials and Methods: From 1989 to 2001, 2,254 patients treated with radical prostatectomy for clinically localized prostate cancer comprised the study cohort. PSA outcome was estimated using the actuarial method of Kaplan and Meier, and was stratified by the presenting PSA level and needle biopsy and prostatectomy Gleason score. Results: The 10-year estimates of PSA outcome declined significantly (p less than or equal to 0.002) for patients with biopsy or prostatectomy Gleason score 6 or less as the presenting PSA level increased. This trend was observed for biopsy and prostatectomy Gleason score 7 or higher except for the PSA 4 or less group which did significantly worse (46% versus 62%, p = 0.03) compared to the PSA greater than 4 to 10 ng./ml. group. This finding may be explained by a low serum free testosterone level and the presence of a significantly higher proportion of prostatectomy Gleason score 8 to 10 disease (25% versus 16%, p = 0.03) in the PSA 4 or less versus greater than 4 to 10 ng./ml. group. Conclusions: Patients with Gleason grade 4 or 5 disease in the radical prostatectomy specimen and a presenting PSA of 4 ng./ml. or less may be androgen deficient and have a significantly lower estimate of 10-year PSA outcome then expected based on the presenting PSA level.