Predicting prostate specific antigen outcome preoperatively in the prostate specific antigen era

Purpose: We evaluated the ability of previously defined risk groups to pred ict prostate specific antigen (PSA) outcome 10 years after radical prostate ctomy in patients diagnosed with clinically localized prostate cancer durin g the PSA era. Materials and Methods: Between 1989 and 2000, 2,127 men with clinically loc alized prostate cancer underwent radical prostatectomy, including 1,027 at Hospital of the University of Pennsylvania (study cohort) and 1,100 at Brig ham and Women's Hospital (validation cohort). Cox regression analysis was d one to calculate the relative risk of PSA failure with the 95% confidence i nterval (CI) in patients at intermediate and high versus low risk. The Kapl an-Meier actuarial method was used to estimate PSA outcome 10 years after r adical prostatectomy. Results: Compared with low risk patients (stages Tlc to 2a disease, PSA 10 ng./ml. or less and Gleason score 6 or less) the relative risk of PSA failu re in those at intermediate (stage T2b disease or PSA greater than 10 to 20 ng./ml. or less, or Gleason score 7) and high (stage T2c disease, or PSA g reater than 20 ng./ml. or Gleason score 8 or greater) risk was 3.8 (95% CI 2.6 to 5.7) and 9.6 (95% CI 6.6 to 13.9) in the study cohort, and 3.3 (95% CI 2.3 to 4.8) and 6.3 (95% CI 4.3 to 9.4) in the validation cohort. The 10 -year PSA failure-free survival rate in the 1,020 patients in the low, 693 in the intermediate and 414 in the high risk groups was 83%, 46% and 29%, r espectively (p <0.0001). Conclusions: Based on 10-year actuarial estimates of PSA outcome after radi cal prostatectomy 3 groups of patients were identified using preoperative P SA, biopsy Gleason score and 1992 clinical T category.