HISTOLOGICAL AND CLINICAL FINDINGS IN 896 CONSECUTIVE PROSTATES TREATED ONLY WITH RADICAL RETROPUBIC PROSTATECTOMY - EPIDEMIOLOGIC SIGNIFICANCE OF ANNUAL CHANGES

Purpose: Recognizing that the unprecedented increase in new cases of p rostate cancer between 1988 and 1996 actually peaked in 1992 and has n ow returned to baseline, we examined our clinical and histological dat abase for annual trends in 896 consecutive men treated only with radic al prostatectomy for clinical stages T1c to T2c from 1988 to 1996. Mat erials and Methods: All radical prostatectomy specimens were examined prospectively in 3 mm. step sections by I pathologist. Using multiple logistic regression for dichotomous variables and multiple linear regr ession for continuous variables, both corrected for age, we assessed t he annual trends for significant changes in T1c versus T2 clinical sta ges, preoperative serum prostate specific antigen (PSA), cancer volume , percent Gleason grade 4/5 in the cancer, location of the cancer in t he transition or peripheral zone, organ confined status, seminal vesic le invasion, positive surgical margins, prostate weight and presence o f clinically insignificant cancers (less than 0.5 cc in volume). Resul ts: There were no significant annual changes in the proportion of perc ent Gleason grade 4/5 cancer, serum PSA, prostate weight or clinically insignificant cancers less than 0.5 cc, and the annual changes for ca ncer volume were only of moderate significance. Tie cancers increased from 10% in 1988 to 73% in 1996 (p = 0.0001), organ confined cancers f rom 40 to 75% (p = 0.0001) and transition zone cancers from 10 to 21% (p = 0.003). Seminal vesicle invasion decreased from 18 to 5% (p = 0.0 01) and positive surgical margins from 30 to 14 (p = 0.006). Mean pati ent age changed from 65 to 62 years (p = 0.0001). Conclusions: We beli eve that the extraordinary rise and fall in prostate cancer detection rates from 1990 to 1994 primarily removed previously undetected T2 can cers from the pool at large, leaving impalpable Tie cancers as the pri mary reservoir of prostate cancers in the United States. Importantly, cancer volume, percent Gleason grade 4/5 cancer, serum PSA and cancers less than 0.5 cc have not had a highly significant change during thes e critical 9 years. These data argue strongly that current PSA testing has not resulted in the detection of clinically insignificant cancers , and that PSA screening should be expanded and not restricted.