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Continuing trends in pathological stage migration in radical prostatectomy specimens
Ithaar H Derweesh1, Patrick A Kupelian, Craig Zippe
1Section of Urologic Oncology, Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Urologic Oncology
|July 31, 2004
Summary
Prostate-specific antigen (PSA) screening significantly reduced rates of extracapsular extension (ECE) in prostate cancer patients treated with radical prostatectomy (RP). This improvement correlates with better biochemical relapse-free survival (bRFS) over time.
Area of Science:
- Urology
- Oncology
- Pathology
Background:
- Prostate-specific antigen (PSA) screening has altered prostate cancer detection.
- Extracapsular extension (ECE) is a negative prognostic factor following radical prostatectomy (RP).
Purpose of the Study:
- To examine trends in ECE rates for prostate cancers detected via PSA screening from 1987 to 2001.
- To analyze the impact of screening on clinical outcomes after RP.
Main Methods:
- Analysis of 1505 patients treated with RP without neoadjuvant hormonal therapy.
- Logistic regression to identify ECE predictors.
- Kaplan-Meier analysis for biochemical relapse-free survival (bRFS).
Main Results:
- ECE rates decreased from 65.8% to 25.2% between 1987 and 2001.
- Year of treatment was an independent predictor of reduced ECE.
- Six-year bRFS improved from 75.1% (1987-1994) to 82.6% (1995-2001).
Conclusions:
- PSA screening has led to a downward pathological stage migration for prostate cancer.
- Improved outcomes, including reduced ECE and enhanced bRFS, are observed in patients treated more recently.