INFLUENCE OF PROSTATE-SPECIFIC ANTIGEN TESTING ON THE SPECTRUM OF PATIENTS WITH PROSTATE-CANCER UNDERGOING RADICAL PROSTATECTOMY AT A LARGEREFERRAL PRACTICE

Objective: To analyze trends in the clinical stage and pathologic outc ome of patients with prostate cancer who underwent radical prostatecto my at a large referral practice during the prostate-specific antigen ( PSA) testing era. Material and Methods: Between January 1987 and June 1995, 5,568 patients with prostate cancer (4,774 with clinically local ized disease of stage T2c or less) underwent pelvic lymphadenectomy an d radical retropubic prostatectomy at our institution. Patient age, pr eoperative serum PSA level, clinical stage, pathologic stage, Gleason score, and tumor ploidy were assessed. Outcome was based on clinical a nd PSA (increases in PSA level of 0.2 ng/mL or more) progression-free survival. Results: Patient age (65 to 63 years old; P<0.001) and serum PSA level (median, 8.4 to 6.8 ng/mL; P<0.001) decreased during the st udy period. The percentage of patients with clinical stage Tie prostat e cancer increased from 2.1% in 1987 to 36.4% in 1995 (P<0.001), and c linical stage T3 cancer decreased from 25.3% to 6.5% (P<0.001). Nondip loid tumors decreased from 38.3% to 24.6% (P<0.001), and the proportio n of patients with pathologically organ-confined disease increased fro m 54.9% to 74.3% (P<0.001). More cT1c than cT2 tumors were diploid (80 % versus 72%; P<0.001), had a Gleason store of 7 or less (75% versus 6 5%; P<0.001), and were confined to the prostate (75% versus 57%; P<0.0 01). Five-year progression-free survival was 85% and 76% for patients with clinical stage T1c and T2, respectively (P<0.001). Conclusion: Si nce the advent of PSA testing, patients referred to our institution fo r radical prostatectomy have shown a significant migration to lower-st age, less-nondiploid, more often organ-confined prostate cancer at the time of initial assessment. Cancer-free survival associated with PSA- detected cancer (cT1c) is superior to that with palpable tumors(cT2). Whether these trends translate into improved long-term cancer-specific survival remains to be confirmed with longer follow-up.