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 prost ate cancer has increased with the advent of prostate specific antigen (PSA) screening. Few series have examined the relapse rates after pros tatectomy relative to pre-treatment prognostic factors, such as preope rative PSA and Gleason score. The characteristics and outcome of patie nts diagnosed with prostate cancer and treated with radical prostatect omy at community hospitals in the prostate specific antigen era have n ot been described in detail. METHODS. The tumor registry records were obtained for all patients diagnosed with prostate cancer and treated w ith radical prostatectomy at Washington Hospital, Fremont, CA, from 19 90 through 1993. The clinical and pathologic characteristics, includin g the original pathology reports, for the 100 patients were reviewed b y a single physician. Relapse was defined by the persistence or appear ance 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 surgic al margin status. The median follow-up time was 2.5 years. RESULTS. Th e 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 p atients, greater than 4 to 10 ng/mL for 38 patients, greater than 10 t o 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 tha n or equal to 5 for 40%, 6 for 17%, 7 for 31%, and 8 to 10 for 12%. Po sitive surgical margins were noted in 30% of the patients. The actuari al probability of overall survival and freedom from relapse for the en tire group of patients at 3 years was 95% and 73%, respectively. Pre-t reatment PSA values greater than 20 ng/mL, Gleason score greater than or equal to 7, and pT3 classification were significant predictors of r elapse 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 than 20 ng/mL or Gleason scores greater than or equal to 7. Overall results o f radical prostatectomy at this community hospital were similar to tho se reported at referral centers. (C) 1996 American Cancer Society.