National patterns of prostate cancer treatment by radical prostatectomy: results of a survey by the American College of Surgeons Commission on Cancer.

To evaluate the patterns of use of radical prostatectomy for the treatment of prostate cancer in the United States, the American College of Surgeons Commission on Cancer in association with the American Cancer Society and American Urological Association surveyed 484 institutions concerning 2,122 patients treated in 1990. The results revealed that 93% of the patients were younger than 75 years when treated. Pretreatment prostate specific antigen level was greater than 4.0 ng./ml. in 85.4% of the patients. Surgical-pathological evaluation showed that 57.5% of the patients treated had American Joint Committee on Cancer pathological stages O, I and II corresponding to American Urological Association stages A1 to B2. Positive pathological findings, for example microscopic tumor extension or invasion, were associated with elevated prostate specific antigen levels at followup. The mortality rate associated with the operation was 0.7%. Impotence following treatment was observed in 56.6% of the patients who were potent preoperatively and complete incontinence was reported in 3.6% of the patients who were previously continent. The data may provide benchmarks by which further trends in prostate cancer treatment may be compared.