Biochemical recurrence after radical prostatectomy for prevalent versus incident cases of prostate cancer: Implications for management

BACKGROUND. Among screened populations, it is unknown whether men with prostate cancer (PC) diagnosed at the initial screening (prevalent cases) have a different outcome than men who are diagnosed at subsequent screenings (incident cases) after adjusting for known prognostic factors. METHODS. The current study cohort was comprised of 1923 men from a prospective PC screening study who underwent radical prostatectomy (RP) between September 19, 1989 and May 22, 2002. Cox regression multivariate analysis was used to determine whether having prevalent PC versus incident PC was associated with the time to prostate-specific antigen (PSA) failure after RP after adjusting for PSA level, Gleason score, clinical tumor (T) classification, and year of RP. RESULTS. Men with prevalent PC had higher PSA levels (P < .001) and more advanced clinical T classification (P < .001) than men with incident PC. After a median follow-up of 6.1 years, factors that were associated with a significantly shorter time to PSA failure after RP were prevalent PC (adjusted hazard ratio [AHR], 1.8; 95% confidence interval [95% CI], 1.3-2.6; P = .0005), baseline PSA (AHR, 1.07; 95%CI, 1.04-1.09; P < .001), Gleason 7 disease (AHR, 2.5; 95% CI, 1.9-3.3; P < .001), Gleason 8 to 10 disease (AHR, 2.3; 95%CI, 1.5-3.5; P < .001), and the year of RP (AHR, 0.92; 95%CI, 0.86-0.97; P = .003). Men with prevalent PC also had worse outcomes after adjusting for their more advanced pathologic features. CONCLUSIONS. After adjusting for known prognostic factors, men with prevalent PC had a poorer outcome after RP than men with incident PC. The authors believe that this finding should be taken into consideration when weighing the risk of recurrence and treatment options for men who are diagnosed with PC on their initial screening.