Improved stage and grade-specific progression-free survival rates after radical prostatectomy in the PSA era

Since the initiation of prostate-specific antigen (PSA) screening, the progression-free survival (PFS) rates after radical prostatectomy have markedly improved. However, few studies have evaluated whether PFS has improved for stage and grade-matched patients. Our objective was to examine differences in PFS after radical prostatectomy between the pre-PSA era (before 1992) and the PSA era, controlling for tumor stage and grade.

From 1983 to 2003, 3456 men underwent radical prostatectomy by one surgeon. The 10-year PFS rates were calculated for each era and stratified by pathologic tumor stage and grade. Kaplan-Meier curves were generated to show biochemical PFS over time.

The proportion of patients with pathologically organ-confined disease increased from 64% to 69%, consistent with stage migration. The PFS rate in the PSA era was 87%, 63%, 58%, and 31% versus 71%, 63%, 47%, and 19% in the pre-PSA era for Stage pT2R0, pT3R0, pT2-T3R1, and pT3c/N1 disease, respectively. The PFS rate stratified by Gleason grade in the PSA era was 84%, 63%, and 37% versus 66%, 49%, and 32% in the pre-PSA era for Gleason grade less than 7, 7, and 8 to 10, respectively. The 10-year PFS rate for organ-confined disease improved from 70% in the pre-PSA era to 86% in the PSA era.

Patients treated with radical prostatectomy in the PSA era have improved survival outcomes when controlling for pathologic stage and grade. This is likely attributed to the earlier detection of cancer through PSA screening, better identification of patients amenable to curative therapy, and the effects of lead-time bias.