Long‐term outcomes after radical prostatectomy performed in a community‐based health maintenance organization

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Abstract
BACKGROUND: Radical prostatectomy is used widely for the treatment of patients with localized prostate carcinoma. No long‐term analysis has been reported on a series of radical prostatectomies performed in a community‐based health maintenance organization.METHODS: Charts and histologic slides were reviewed from 750 patients who underwent radical prostatectomy between 1970 and 1996 at a community‐based health maintenance organization. The influences of a number of variables were analyzed for their impact on progression free survival (PFS) and overall survival (OS).RESULTS: With a median follow‐up of 6.2 years among survivors, 137 patients (18%) had progressive disease, and 149 patients (20%) died from all causes. The median OS from the date of diagnosis was 15.7 years (95% confidence interval, 13.6–17.2), similar to the expected median survival of 16.2 years. The median PFS from diagnosis was not reached, but 75% of patients were progression free ≥ 10.6 years after undergoing prostatectomy. The prognostic factors included Gleason score, age at diagnosis, and T stage. Outcomes were comparable with reports of surgical series from university‐based practices.CONCLUSIONS: The patient characteristics that had important, favorable correlation with survival included Gleason score ≤ 6, T1 or T2 tumor status, and younger age at diagnosis. Lower prostate‐specific antigen values at diagnosis, together with the former two parameters, also had a favorable correlation with PFS. Radical prostatectomy in a community‐based health maintenance organization was followed by long‐term PFS and OS comparable to outcomes reported from university‐based practices. The impact of radical prostatectomy on survival remains to be demonstrated. Cancer 2004;100:300–7. © 2003 American Cancer Society.