Long-Term Outcomes after Radical Prostatectomy Performed in a Community-Based Health Maintenance Organization

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.