Initial PSA >20？ng/mL is generally considered an adverse prognostic feature in prostate cancer (PCa). Our goals were to estimate the impact of radical prostatectomy (RP) on biochemical recurrence- (BCR-) free and cancer-specific survival (CSS) rates of PCa patients with PSA >20？ng/mL, and to identify patients with favorable oncological outcome. Using 20？ng/mL as a cut-point value, 205 PCa patients, who underwent RP, were stratified into two groups. Multivariate analysis was used to determine the significant outcome predictors among patients with PSA >20？ng/mL. Men in this group had significantly lower 10-yr BCR-free and CSS rates than patients with PSA ≤20？ng/mL (20.7% versus 79.6% ( ) and 65.0% versus 87.9% ( ), resp.). Pathological stage and lymph node status were found to be the only independent predictors of PSA failure. Patients with favorable combination of these variables (pT2, N0) had significantly longer 10-yr BCR-free and CSS rates (44.3% versus 0% ( ) and 100.0% versus 33.6% ( ), resp.). High PSA values do not uniformly indicate poor prognosis after surgery. Patients, who might benefit the most from RP, are those with organ confined PCa and negative lymph nodes. 1. Introduction The stage migration of prostate cancer (PCa), due to its prostate-specific antigen (PSA-) based early detection, dramatically changed the pattern of presentation in many patients with potentially lethal disease. Nowadays, an increasing number of patients are initially diagnosed with cancer confined to the prostate. However, approximately one third of these men are found to have aggressive pathological features by the final histological report: extraprostatic extension (EPE), seminal vesicle invasion (SVI), and/or lymph node involvement (LNI) [1, 2]. These numbers could be even higher, if a more aggressive treatment policy of performing radical prostatectomy (RP) is implemented [3, 4]. PSA is one of the most established tumor markers that is widely used in screening, diagnosis, staging, and monitoring of prostate cancer patients [5, 6]. PSA has an established prognostic impact and is one of the three basic parameters (together with the biopsy Gleason score and the clinical stage) that is included in all preoperative prognostic tools [5, 7–9]. Serum PSA above 20？ng/mL is generally considered as an adverse prognostic feature in PCa, associated with a higher prevalence of a locally advanced disease and/or distant metastases [10, 11] and with a higher probability of developing recurrent disease after radical local treatment [7, 9, 12]. Therefore, many urologists are
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