Radical prostatectomy outcomes during prostate-specific antigen era in Ireland compared to a matched American population

Objectives: To examine temporal trends in clinico-pathological outcomes following radical prostatectomy (RP) in Ireland over time, and perform matched comparison of between Ireland and the USA based upon initiation of prostatespecific antigen (PSA) screening. Methods: Between 2000-2010, 651 RPs were carried out at a single institution in Ireland. Clinic-pathologic tumor features were compared to 1302 men treated in the USA from the same time interval (matching on year of diagnosis, 1:2 ratio). As historical comparison, we included a separate group of 150 USA men who underwent RP during the early PSA era (1990-1992). Results: We observed a downward migration in biopsy tumor burden (p=0.002), RP tumor volume (p<0.001) and pathologic stage (p=0.001) in Irish men. In comparison to USA men (same interval), Irish patients had higher percentage Gleason 7-10 prostate cancer (p=0.003), higher median tumor volume (20% versus 8%, p<0.0001), and marginally higher stage disease (pT3 20% versus 16.7%, p=0.06). In comparison to USA men from the early PSA era (1990-1992) Irish men are younger (p<0.001), have more high-grade disease on both biopsy (p=0.001) and RP (p<0.001) specimens. Although there is no significant difference between tumor volumes between both eras, Irish men are more likely to have organ-confined disease (p=0.02). Conclusions: During the past decade of increasing PSA utilization in Ireland, we found evidence of pathological stage migration. In comparison to a USA population, Irish men have worse pathological characteristics, however, in comparison to the early USA PSA era, Irish men are more likely to have organ-confined disease.