Elsevier

Urology

Volume 61, Issue 4, April 2003, Pages 736-741
Urology

Adult urology
Time trends in biochemical recurrence after radical prostatectomy: results of the SEARCH database

https://doi.org/10.1016/S0090-4295(02)02526-8Get rights and content

Abstract

Objectives

To determine whether in the prostate-specific antigen (PSA) era stage and/or grade migration of patients treated with radical prostatectomy (RP) has occurred. We also examined whether the biochemical recurrence rates after RP have changed with time.

Methods

A total of 1654 patients from the Shared Equal Access Regional Cancer Hospital (SEARCH) database were analyzed for time trends in age, preoperative PSA level, clinical stage, biopsy Gleason score, prostatectomy Gleason grade, pathologic stage, margin status, and recurrence rates after RP. Results were stratified into three 4-year blocks of time between 1988 and 2002 for analysis.

Results

The preoperative PSA level, patient age, tumor stage, rate of capsular penetration, and lymph node involvement decreased with time. Both biopsy and pathologic Gleason grade steadily increased with time. The positive margin rate and incidence of seminal vesicle involvement remained stable. On multivariate analysis, only serum PSA level (P <0.001) and biopsy Gleason score (P <0.001) were significant independent predictors of the time to recurrence after RP. The year of surgery was not a significant independent predictor of biochemical recurrence after RP in multivariate analysis.

Conclusions

Despite lower stage and lower PSA levels with time, we found no improvement in PSA recurrence rates over time. This may reflect lead-time bias in detecting PSA recurrence by the use of more sensitive PSA assays in recent years.

Section snippets

Material and methods

After each institution provided institutional review board approval, patients undergoing RP since 1988 at the Veterans Affairs (VA) Health Care Facilities in West Los Angeles, Palo Alto, and San Francisco, as well as the San Diego Naval Hospital, were combined into one database, the SEARCH database.

Patients treated with preoperative androgen deprivation or radiotherapy were excluded. This resulted in a study population of 1684 patients. Patients were grouped into three groups on the basis of

Results

The clinical characteristics of the study population are shown in Table I. The annual number of patients undergoing RP steadily increased until 1992 and remained relatively stable since. Over time, the increase in the percentage of patients with clinical T1 tumors was steady and significant. The preoperative serum PSA level and median age at the time of surgery steadily declined with time. A steady rise in biopsy Gleason scores occurred over time. This was largely due to an increase in the

Comment

The introduction of PSA testing has had a dramatic impact on the incidence and treatment of prostate cancer. The incidence of localized disease and thus the number of men who are candidates for curative treatments, including RP, increased significantly. This gave rise to concern that many men who had clinically insignificant tumors would be subjected to potentially morbid and unnecessary treatments. We found that during the PSA era, the average age of men undergoing RP decreased significantly.

Conclusions

During the PSA era and among our patient population, a steady shift was found for men to undergo surgery at younger ages and for earlier stage disease. However, the mean Gleason scores increased over time. Despite this stage migration, we found no improvement in PSA recurrence rates with time. This may reflect lead-time bias in detecting PSA recurrence by the use of more sensitive PSA assays.

References (27)

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This study was supported in part by the Department of Veterans Affairs and a Center for Prostate Disease Research grant from the United States Army Medical Research and Material Command.

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