Changes in prostate cancer at radical prostatectomy during the prostate specific antigen era: an Italian experience.
OBJECTIVE
To assess changes in prostate cancer clinical and pathologic features by review of 15 years' experience with radical prostatectomy.


METHODS
A total of 596 consecutive patients who underwent open or laparoscopic radical prostatectomy (RP) between 1991 and 2006 were included. All had clinically localized prostate cancer. Surgical specimens were analyzed or blindly reviewed by a uropathologist, and whole-mount sections were prepared. Statistical analysis evaluated whether significant changes in clinical and pathologic variables occurred over time.


RESULTS
Median prostate specific antigen (PSA) values at diagnosis significantly decreased over time. Definite stage migration was observed, with significant increase of organ-confined tumors. Incidence of seminal vesicle and lymph node involvement declined steadily. Median tumor volume decreased significantly over time (p<0.001). Incidence of nonsignificant cancers at RP increased significantly, reaching 25.6% in 2006. PSA value has progressively lost correlation with prostate cancer volume and today correlates only with prostate gland volume.


CONCLUSIONS
Prostate cancer stage and volume at diagnosis have steadily decreased in the last 15 years, likely reflecting increasing use of PSA testing. In early prostate cancer, PSA level no longer correlates with tumor volume.
Bollito
Enrico
E
Department of Pathology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy.
Terrone
Carlo
C
Volpe
Alessandro
A
Porpiglia
Francesco
F
Cracco
Cecilia
C
Poggio
Massimiliano
M
Grande
Susanna
S
Righi
Luisella
L
Bellina
Maurizio
M
Papotti
Mauro
M
Scarpa
Roberto Mario
RM
D000230:Adenocarcinoma / Q000097:blood / Q000473:pathology* / Q000601:surgery; D000368:Aged; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery; D012016:Reference Values; D012669:Seminal Vesicles / Q000473:pathology
D017430:Prostate-Specific Antigen