Impact of Radical Prostatectomy in the Management of Clinically Localized Disease

The cancer specific death rate following radical prostatectomy in patients with organ confined and specimen confined disease was 10% at 13.5 years, less than the noncancer death rate of 20% for patients in these disease extent categories. The median age of all patients in these categories was 65 years. Cancer remains the dominate cause of death in patients with margin-positive disease, being 40% at 13.5 years. Disease detected by prostate specific antigen (PSA) rather than digital rectal examination appears to be of smaller volume and to have a higher probability of negative margins. Data argue that early detection of PSA will shift patients to a more favorable disease category at surgical intervention. Disease recurrence or persistence by PSA detection seems to precede clinical detection of disease by 3 to 5 years. Disease recurrence by PSA detection does not predict survival outcome, probably does not differentiate between local and distant microscopic recurrence, and is not predictive of biological aggressiveness.