Evolution of the presentation and pathologic and biochemical outcomes after radical prostatectomy for patients with clinically localized prostate cancer diagnosed during the PSA era

Objectives. To demonstrate the evolution of the clinical presentation and pathologic and biochemical outcomes for patients with clinically localized prostate cancer treated with radical prostatectomy during the prostate-specific antigen (PSA) era. Methods. One thousand fifty-nine consecutive men treated with radical prostatectomy from January 1989 to December 2000 comprised the study cohort. A chi-squared metric was used to compare the proportions of patients during three intervals (1989 to 1992, 1993 to 1996, and 1997 to 2000) by categories of PSA level, biopsy Gleason score, clinical T stage, percent positive biopsy cores, age, and risk group, as well as pathologic T stage, Gleason score, margin status, and lymph node status. Actual 2-year PSA recurrence-free survival rates are reported for patients with a minimal follow-up of 24 months, stratified by the interval and preoperative risk group. Results. There was a significant shift in the preoperative characteristics toward younger patients (P <0.0001) with nonpalpable disease (P <0.0001), lower PSA levels (P <0.0001), fewer percent positive biopsies (P <0.0001), and lower preoperative risk group classification (P <0.0001). Pathologically, a significant downward stage migration was found toward organ-confined disease (P <0.0001) and improvement in surgical margin status (P < 0.001). The actual 2-year PSA recurrence-free survival rates improved during the three intervals spanning the PSA era from 60% to 78% and 82% (P <0.0001). Conclusions. With the introduction of serum PSA as a screening tool, we have noted an evolution toward a lower pathologic stage, grade, and improved PSA outcome. These findings provide further support that serum PSA screening increases the proportion of patients potentially curable after radical prostatectomy.