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Multi-institutional Pooled Analysis

Glenn S. Gerber, MD; Ronald A. Thisted, PhD; Peter T. Scardino, MD; Hubert G. W. Frohmuller, MD; Fritz H. Schroeder, MD; David F. Paulson, MD; Anthony W. Middleton, Jr, MD; Daniel B. Rukstalis, MD; Joseph A. Smith, Jr, MD; Paul F. Schellhammer, MD; Makoto Ohori, MD; Gerald W. Chodak, MD

JAMA. 1996;276(8):615-619.

Abstract
Objective.
—To assess the results of radical prostatectomy in men with early prostate cancer.

Design.
—Retrospective, nonrandomized, multi-institutional pooled analysis.

Setting.
—Eight university medical centers in the United States and Europe.

Patients.
—A total of 2758 men with stage T1 and T2 prostatic cancer.

Main Outcome Measures.
—Disease-specific and metastasis-free survival rates.

Results.
—Tumor grade was the most important preoperative factor in determining outcome. Disease-specific survival 10 years following surgery and associated 95% confidence intervals were 94% (range, 87%-98%), 80% (range, 74%-85%), and 77% (range, 65%-86%) for those men with grade 1, 2, and 3 tumors, respectively. Metastasis-free survival at 10 years was 87% (range, 78%-92%), 68% (range, 62%-73%), and 52% (range, 38%-64%) for patients with grade 1, 2, and 3 cancers, respectively.

Conclusions.
—Radical prostatectomy leads to high 10-year disease-specific survival rates in men with all tumor grades. However, caution is needed in comparing these results with similar studies of alternative treatment strategies, such as watchful waiting, due to the inherent potential biases in uncontrolled trials. Nevertheless, these results offer the best currently available estimates of 10-year outcome of radical prostatectomy in men with clinically localized prostate cancer and may be useful in counseling patients with early malignancy.

Author Affiliations
From the Section of Urology, Department of Surgery (Drs Gerber, Rukstalis, and Chodak), and the Departments of Statistics and Anesthesia and Critical Care (Dr Thisted), and the Cancer Research Center (Dr Thisted), University of Chicago (III) Pritzker School of Medicine; Department of Urology, Baylor College of Medicine, Houston, Tex (Drs Scardino and Ohori); Department of Urology, University of Würzburg (Germany) (Dr Frohmuller); Institute of Urology, Erasmus University, Rotterdam, the Netherlands (Dr Schroeder); Division of Urology, Department of Surgery, Duke University School of Medicine, Durham, NC (Dr Paulson); Department of Urology, University of Utah School of Medicine, Salt Lake City (Dr Middleton); Department of Urology, Vanderbilt University School of Medicine, Nashville, Tenn (Dr Smith); and Department of Urology, Eastern Virginia Medical School, Norfolk (Dr Schellhammer).

Footnotes
Reprints: Glenn S. Gerber, MD, University of Chicago, Section of Urology/MC6038, 5841 S Maryland Ave, Chicago, IL 60637.

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