Survival results in patients with screen-detected prostate cancer versus physician-referred patients treated with radical prostatectomy: early results.
OBJECTIVE
Screening using a standardized protocol may improve outcomes of patients undergoing treatment for prostate cancer. We compared the 7- year progression-free survival rates after radical retropubic prostatectomy in patients whose prostate cancer was detected through a formal screening program with those of patients referred for treatment by other physicians who did not use a standardized screening/referral protocol.


METHODS
A single surgeon (W.J.C.) performed radical retropubic prostatectomy in 3,177 consecutive patients between 1989 and 2003. Of these patients, 464 had cancer detected in a screening study, and 2,713 were referred from outside institutions. We compared the screened and referred cohorts for age at surgery, clinical stage, pathologic stage, Gleason sum, preoperative prostate-specific antigen (PSA) levels, and adjuvant radiation therapy. Kaplan-Meier product limit estimates were used to calculate 7-year progression-free probabilities, and Cox proportional hazards models were used to determine the clinical and pathologic parameters associated with cancer progression in each group.


RESULTS
The overall 7-year progression-free survival rates were 83% for the screened patients compared with 77% for the referred patients (P = 0.002). Preoperative PSA, Gleason sum, clinical stage, pathologic stage, and adjuvant radiotherapy were all significantly associated with cancer progression. There was a significantly higher proportion of referred patients with a preoperative PSA > or =10, Gleason sum > or =7, and nonorgan-confined disease.


CONCLUSIONS
Patients with screened-detected prostate cancer have more favorable clinical and pathologic features, and 7-year progression-free survival rates than referred patients. On multivariate analysis, including other clinical variables, screening status was a significant independent predictor of biochemical outcome.
Roehl
Kimberly A
KA
Department of Psychiatry, Washington University School of Medicine, St Louis, MO 63105, USA.
Eggener
Scott E
SE
Loeb
Stacy
S
Smith
Norm D
ND
Antenor
Jo Ann V
JA
Catalona
William J
WJ
D000368:Aged; D002277:Carcinoma / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D018450:Disease Progression; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D016019:Survival Analysis
D017430:Prostate-Specific Antigen