The results of radical prostatectomy at a community hospital during the prostate specific antigen era.

BACKGROUND

The use of radical prostatectomy in the treatment of prostate cancer has increased with the advent of prostate specific antigen (PSA) screening. Few series have examined the relapse rates after prostatectomy relative to pre-treatment prognostic factors, such as preoperative PSA and Gleason scores. The characteristics and outcome of patients diagnosed with prostate cancer and treated with radical prostatectomy at community hospitals in the prostate specific antigen era have not been described in detail.

METHODS

The tumor registry records were obtained for all patients diagnosed with prostate cancer and treated with radical prostatectomy at Washington Hospital, Fremont, CA, from 1990 through 1993. The clinical and pathologic characteristics, including the original pathology report, for the 100 patients were reviewed by a single physician. Relapse was defined by the persistence or appearance of a PSA value greater than 0.2 ng/mL (Hybritech, Inc., San Diego, CA) following surgery or by clinical evidence of recurrent disease. Crude and actuarial probabilities of relapse were analyzed relative to pre-treatment PSA values, Gleason score, pathologic stage, and surgical margin status. The median follow-up time was 2.5 years.

RESULTS

The pT-classification distribution of the 100 cases was as follows: T1, 4%; T2A, 14%; T2B, 11%; T2C, 49%; T3A, 8%; T3B, 2%; T3C, 6%; and N+, 6%. Pretreatment PSA values were less than or equal to 4 ng/mL for 10 patients, greater than 4 to 10 ng/mL for 38 patients, greater than 10 to 20 ng/mL for 27 patients, and greater than 20 ng/mL for 13 patients. The value was unknown for 12 patients. The Gleason score was less than or equal to 5 for 40%, 6 for 17%, 7 for 31%, and 8 to 10 for 12%. Positive surgical margins were noted in 30% of the patients. The actuarial probability of overall survival and freedom from relapse for the entire group of patients at 3 years was 95% and 73%, respectively. Pre-treatment PSA values greater than 20 ng/mL, Gleason score greater than or equal to 7, and pT3 classification were significant predictors of relapse in univariate analysis. Preoperative PSA greater than 20 ng/mL and Gleason score were significant prognostic factors in multivariate analysis. Pathologic margin status was not a significant predictor of relapse in this experience.

CONCLUSIONS

Short-term relapse rates are high among those patients with preoperative PSA values greater then 20 ng/mL or Gleason scores greater than or equal to 7. Overall results of radical prostatectomy at this community hospital were similar to those reported at referral centers.