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Case selection for radical prostatectomy in the UK.

M H Winkler1, F A Khan, B Blake-James

  • 1Whipps Cross University Hospital, Whipps Cross Road, Leytonstone, London E11, UK. m.winkler@ukonline.co.uk

European Urology
|September 15, 2004
PubMed
Summary
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Radical prostatectomy outcomes in the UK improved with better patient selection based on pre-operative prostate-specific antigen (PSA) levels. A PSA cutoff of less than 12 ng/ml may optimize patient selection for improved recurrence-free survival.

Area of Science:

  • Urology
  • Oncology
  • Clinical Audit

Background:

  • Radical prostatectomy is a common treatment for localized prostate cancer.
  • UK data on prostate-specific antigen (PSA) recurrence after surgery is limited, hindering optimal case selection.
  • This study audited PSA recurrence rates across five English centers.

Purpose of the Study:

  • To audit PSA recurrence after radical prostatectomy in the UK.
  • To investigate the utility of pre-operative PSA levels in improving case selection and patient outcomes.

Main Methods:

  • Retrospective audit of 854 patient records from five UK centers.
  • Exclusion of patients receiving neoadjuvant/adjuvant therapy or with incomplete data.
  • Analysis of pre-operative staging and follow-up data for 663 eligible patients.

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Main Results:

  • Median follow-up was 52 months. Overall 8-year PSA recurrence-free survival was 48%.
  • Five-year PSA recurrence-free survival varied significantly by pre-operative PSA: 82% (<4 ng/ml), 73% (4.1-10 ng/ml), 59% (10.1-20 ng/ml), and 20% (>20 ng/ml).
  • Simulations suggest a pre-operative PSA cutoff of <12 ng/ml improves outcomes without further benefit from stricter cutoffs.

Conclusions:

  • PSA recurrence-free survival has improved in England over time, likely due to better case selection.
  • UK recurrence-free survival rates are lower than reported American figures.
  • A pre-operative PSA threshold of <12 ng/ml is recommended for optimizing radical prostatectomy case selection.