title: Long-term outcomes after radical prostatectomy performed in a community-based health maintenance organization.
abstract: BACKGROUND
  Radical prostatectomy is used widely for the treatment of patients with localized prostate carcinoma. No long-term analysis has been reported on a series of radical prostatectomies performed in a community-based health maintenance organization.
  
  
  METHODS
  Charts and histologic slides were reviewed from 750 patients who underwent radical prostatectomy between 1970 and 1996 at a community-based health maintenance organization. The influences of a number of variables were analyzed for their impact on progression free survival (PFS) and overall survival (OS).
  
  
  RESULTS
  With a median follow-up of 6.2 years among survivors, 137 patients (18%) had progressive disease, and 149 patients (20%) died from all causes. The median OS from the date of diagnosis was 15.7 years (95% confidence interval, 13.6-17.2), similar to the expected median survival of 16.2 years. The median PFS from diagnosis was not reached, but 75% of patients were progression free > or = 10.6 years after undergoing prostatectomy. The prognostic factors included Gleason score, age at diagnosis, and T stage. Outcomes were comparable with reports of surgical series from university-based practices.
  
  
  CONCLUSIONS
  The patient characteristics that had important, favorable correlation with survival included Gleason score < or = 6, T1 or T2 tumor status, and younger age at diagnosis. Lower prostate-specific antigen values at diagnosis, together with the former two parameters, also had a favorable correlation with PFS. Radical prostatectomy in a community-based health maintenance organization was followed by long-term PFS and OS comparable to outcomes reported from university-based practices. The impact of radical prostatectomy on survival remains to be demonstrated.
authors.affiliation: Department of Oncology, Lombardi Cancer Center, Georgetown University, 3800 Reservoir Road NW, Washington, DC 20007, USA.
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhang
authors.forename: Andrew
authors.initials: A
authors.lastname: Glass
authors.forename: Nicole
authors.initials: N
authors.lastname: Bennett
authors.forename: Karen A
authors.initials: KA
authors.lastname: Oyama
authors.forename: Edmund
authors.initials: E
authors.lastname: Gehan
authors.forename: Edward P
authors.initials: EP
authors.lastname: Gelmann
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006279:Health Maintenance Organizations; D006801:Humans; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome