Adult urologyImproved Stage and Grade-Specific Progression-Free Survival Rates After Radical Prostatectomy in the PSA Era
Section snippets
Patients
Anatomic radical prostatectomy with pelvic lymph node dissection was performed by one surgeon (W.J.C.) on 3456 consecutive men from 1983 to 2003, using a previously reported technique.12 The extent of pelvic lymphadenectomy was similar throughout the study period.12 Men were categorized into two groups stratified by the treatment era: the pre-PSA screening era (1983 to 1991) and the PSA screening era (1992 to 2003). The eras were defined because PSA was initially reported as a first-line
Clinical Characteristics
A total of 3456 men were treated with radical prostatectomy (Table 1). The mean patient age was 65 years in the pre-PSA era and 60 years in the PSA era. The median PSA level in the pre-PSA era was 7.4 ng/mL and was 5.7 ng/mL in the PSA era. The median follow-up of patients in the PSA era was 42 months compared with 139 months in the pre-PSA era (P <0.0001). Five-year follow-up data were available for 1635 patients (47%), and 10-year follow-up data were available for 587 patients (17%); 53
Comment
Prostate cancer management has evolved considerably during the past 25 years. The introduction of PSA testing in the late 1980s, and its widespread use in screening programs in the early 1990s, has resulted in the earlier detection of cancer in younger patients.16 Newer models to predict the pathologic stage from preoperative parameters have allowed improved identification of patients with localized disease.4 As a result of these changes, more patients are identified at a time when their
Conclusions
The changes in the management of prostate cancer during the past decade, including the initiation of PSA screening and better biopsy strategies and surgical techniques, have improved the PFS of patients currently undergoing treatment. Our studies have shown within each individual pathologic stage and grade, improved PFS in the PSA era. The success of a good screening program, including stage migration, a reduction in metastatic disease, and a reduction in mortality, has now been noted. The
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This study was supported in part by Beckman Coulter, Incorporated, Fullerton, California, and the Urological Research Foundation.
Beckman Coulter provided the PSA kits at cost to W. J. Catalona.