Changing prostate-specific antigen outcome after surgery or radiotherapy for localized prostate cancer during the prostate-specific antigen era.
OBJECTIVE
To evaluate the change in prostate-specific antigen (PSA) outcome after radical prostatectomy (RP) or external beam radiotherapy (EBRT), controlling for follow-up during the PSA era.


METHODS
The study cohort consisted of 1440 patients with clinically localized prostate cancer managed with RP (n = 1059) or EBRT (n = 381) between 1989 and 2000. A single genitourinary pathologist reviewed all pathology specimens. For patients with a 2-year minimal follow-up, the 2-year actual PSA outcome stratified by risk group (low vs. high) was calculated for three periods (January 1, 1989 to December 31, 1992; January 1, 1993 to December 31, 1996; and January 1, 1997 to December 31, 2000) and compared for each treatment modality. PSA failure was defined using the American Society for Therapeutic Radiology and Oncology consensus definition for all patients, and comparisons were made using a chi-square metric.


RESULTS
During the study period, the proportion of patients treated with RP and EBRT with low-risk disease increased significantly (p <0.0001) from 60% to 89% and from 26% to 76%, respectively. In addition, the 2-year actual PSA outcome also improved from 60% to 82% (RP: p < 0.0001) and from 67% to 91% (RT: p = 0.0008). The 2-year actual PSA outcome was not significantly different in the low-risk patients but improved during the three periods in the high-risk patients treated with RP (from 20% to 39% to 75%, p = 0.0004) or EBRT (from 50% to 59% to 83%, p = 0.01). This improvement in PSA outcome could be explained by a shift toward a more favorable PSA level (RP: p = 0.0002; RT: p = 0.006) and clinical T stage (RP: p = 0.0008, RT: p < 0.0001) distribution for patients with biopsy Gleason score >or=7 disease.


CONCLUSIONS
Improved PSA outcome during the PSA era after RP or EBRT has resulted from a shift in presentation toward low-risk disease and earlier detection of high-grade disease.
D'Amico
Anthony V
AV
Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA 02115, USA. adamico@lroc.harvard.edu
Chen
Ming-Hui
MH
Oh-Ung
Jean
J
Renshaw
Andrew A
AA
Cote
Kerri
K
Loffredo
Marian
M
Richie
Jerome P
JP
D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D018570:Risk Assessment; D016896:Treatment Outcome
D017430:Prostate-Specific Antigen