Publications

Abstract

BACKGROUND: In North America and Europe widespread PSA testing has resulted in prostate cancer (PC) stage migration, questioning the utility of prognostic nomograms in this setting. OBJECTIVE: We investigated the effect of PSA testing on stage migration in an Australian population and its consequences on the prognostic accuracy of the post radical prostatectomy (RP) Kattan nomogram. DESIGN, SETTING AND PARTICIPANTS: 1008 men who underwent consecutive RP for localised PC between 1991 and 2001 at a single institution entered the study. Two cohorts were assessed: 1991-1996, early PSA era, and 1997-2001, contemporary PSA era. Differences in clinico-pathologic features between the two groups were analysed by chisquared testing and survival modeling. Individual patient data was entered into the post-RP Kattan Nomogram and the efficacy assessed by ROC curve analysis. RESULTS AND LIMITATIONS: Patients in the contemporary PSA era had lower pathologic stage disease (P = .01) and less cancers with Gleason score ?8 (P < .0001) compared to the early PSA cohort. Multivariate analysis identified pre-operative serum PSA level (P < .01) and Gleason score (P < .01) as strong predictors of biochemical relapse in both cohorts. In the contemporary cohort, pathologic stage was not significant, but margin involvement became highly significant (P = .004). There was no difference in the predictive accuracy of the Kattan nomogram between the two groups (P = .253). The limitation of this study is that it is retrospective. CONCLUSIONS: The findings demonstrate downward stage migration towards organconfined disease after the introduction of widespread PSA testing in an Australian cohort. Despite this, the Kattan nomogram remains a robust prognostic tool in clinical practice.