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Case selection for radical prostatectomy in the UK

Winkler, MH; Khan, FA; Blake-James, B; Okeke, AA; Sugiono, M; McInerney, P; ... Gillatt, DA; + view all (2004) Case selection for radical prostatectomy in the UK. European Urology , 46 (4) 444 - 450.

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Abstract

Introduction: Radical prostatectomy is an increasingly popular treatment option for clinically localised prostate cancer, yet PSA outcome figures are rare in the UK. This makes it difficult to establish appropriate criteria for case selection. We conducted an audit of PSA recurrence of 5 large centres in the south of England and investigated the use of pre-operative PSA to improve case selection and outcome. Method: 854 patients notes were audited for pre-operative staging parameters and follow-up data obtained. Patients with neoadjuvant and adjuvant treatment as well as patients with incomplete data and follow- up were excluded. Result: Median follow-up was 52 months for the remaining 663 patients. Median PSA was 10 ng/ml. A large improvement of PSA recurrence free survival rates was observed from 1988 to 1998 as a result of change in case selection and stage migration. 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. Five-year PSA recurrence free survival probability for PSA ranges <4 ng/ml, 4.1-10 ng/ml, 10.1-20 ng/ml and >20 ng/ml was 0.82, 0.73, 0.59 and 0.20, respectively (Wilcoxon, p < 0.0001). A simulation of biochemical recurrence free survival for patient cohorts with stepwise reduced inclusion PSAs suggests an improved outcome for patients with a pre-operative inclusion PSA of < 12 ng/ml. Further reduction of the inclusion PSA does not improve outcome. Conclusion: Intermediate PSA recurrence free survival has improved over time in England. PSA recurrence free survival estimates are less optimistic compared to frequently quoted American figures. A reduced pre-operative PSA cut-off, for case selection may be used to improve outcome. (C) 2004 Elsevier B.V. All rights reserved

Type:Article
Title:Case selection for radical prostatectomy in the UK
Additional information:WoS ID: 000224142700007 JournalArticleOCT857UBEUR UROL
Keywords:adenocarcinoma, ANTIGEN, CANCER CONTROL, DATABASE, ERA, POSITIVE SURGICAL MARGINS, prostate cancer, prostate neoplasm, prostate specific antigen, PSA, QUALITY-OF-LIFE, radical prostatectomy, Recurrence, RETROPUBIC PROSTATECTOMY, stage, SURVIVAL, treatment, trends
UCL classification:UCL > School of Life and Medical Sciences > Faculty of Medical Sciences > Surgery and Interventional Science (Division of)

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