Time trends in case selection, stage and prostate-specific antigen recurrence after radical prostatectomy: a multicentre audit.
OBJECTIVE
To report an audit of preoperative staging variables, case selection, stage migration and prostate-specific antigen (PSA) recurrence at five large centres in the south of England. To establish PSA outcome values after radical prostatectomy for clinically localized prostate cancer in the UK, and enable appropriate patient counselling.


METHODS
The notes of 854 patients were audited for preoperative staging variables and follow-up data obtained. Patients with neoadjuvant and adjuvant treatment, and with incomplete data and follow-up, were excluded.


RESULTS
The median follow-up was 52 months for the remaining 663 patients; the median PSA level was 10 ng/mL. There was a large migration towards lower PSA and stage; this translated into improved PSA survival rates. The overall Kaplan-Meier PSA recurrence-free survival probability at 1, 3, 5 and 8 years was 0.83, 0.69, 0.60 and 0.48, respectively. The 5-year PSA recurrence-free survival probabilities for PSA levels of < 4, 4.1-10, 10.1-20 and > 20 ng/mL were 0.82, 0.73, 0.59 and 0.20, respectively (Wilcoxon, P < 0.001). The PSA recurrence-free survival probabilities for biopsy Gleason grade 2-4, 5 and 6, 7 and 8-10 at 5 years were 0.70, 0.61, 0.55 and 0.21, respectively (Wilcoxon, P < 0.001). Similarly, the 5-year PSA recurrence-free survival probabilities for clinical stages T1a and 1b, T1c, T2a and T2b were 0.79, 0.62, 0.57 and 0.44, respectively (Wilcoxon, P = 0.0012).


CONCLUSIONS
With better case selection the intermediate oncological outcome has improved over time in the UK. PSA recurrence-free survival estimates are less optimistic than the frequently quoted American values. The present values may be used to help in counselling British patients before radical prostatectomy.
Winkler
M H
MH
Royal Free Hospital, London, UK. m.winkler@ukonline.co.uk
Khan
F A
FA
Hoh
I M
IM
Okeke
A A
AA
Sugiono
M
M
McInerney
P
P
Boustead
G B
GB
Persad
R
R
Kaisary
A V
AV
Gillatt
D A
DA
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001706:Biopsy / Q000379:methods; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000175:diagnosis*; D009367:Neoplasm Staging / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy / Q000401:mortality*; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis
D017430:Prostate-Specific Antigen