The relative importance of anatomic and PSA factors to outcomes after radical prostatectomy for prostate cancer.

We report on how anatomic pathology observations and prostate-specific antigen (PSA) observations made before and just after radical prostatectomy relate to subsequent outcomes in men with prostate cancer. Our study patients consisted of more than 200 men who underwent radical prostatectomy and who had a mean follow-up of more than 6 years. We found that there were 2 categories of failures after surgery--one consisting of an eventual elevated PSA level and the other consisting of an early death from progressive tumor--and that these 2 failures related differently to PSA and anatomic pathology observations made at the time of prostatectomy. Whereas preoperative and postoperative levels of PSA related most closely to PSA failure, Gleason grade 5 and the percentage carcinoma related most closely to early death. Our results suggest how men could be sorted into 3 prognostic categories after surgery: one with high hazard for early death, a second with low hazard for early death but with high probability for eventual elevated PSA level, and a third with overall good prognosis.