TIME TRENDS IN BIOCHEMICAL RECURRENCE AFTER RADICAL PROSTATECTOMY: RESULTS OF THE SEARCH DATABASE THE SEARCH DATABASE STUDY GROUP: STEPHEN J. FREEDLAND, JOSEPH C. PRESTI, JR, CHRISTOPHER L. AMLING, CHRISTOPHER J. KANE, WILLIAM J. ARONSON, FREDERICK DOREY, AND MARTHA K. TERRIS ABSTRACT Objectives. To determine whether in the prostate-specific antigen (PSA) era stage and/or grade migration of patients treated with radical prostatectomy (RP) has occurred. We also examined whether the biochemical recurrence rates after RP have changed with time. Methods. A total of 1654 patients from the Shared Equal Access Regional Cancer Hospital (SEARCH) database were analyzed for time trends in age, preoperative PSA level, clinical stage, biopsy Gleason score, prostatectomy Gleason grade, pathologic stage, margin status, and recurrence rates after RP. Results were stratified into three 4-year blocks of time between 1988 and 2002 for analysis. Results. The preoperative PSA level, patient age, tumor stage, rate of capsular penetration, and lymph node involvement decreased with time. Both biopsy and pathologic Gleason grade steadily increased with time. The positive margin rate and incidence of seminal vesicle involvement remained stable. On multivariate analysis, only serum PSA level (P 0.001) and biopsy Gleason score (P 0.001) were significant indepen- dent predictors of the time to recurrence after RP. The year of surgery was not a significant independent predictor of biochemical recurrence after RP in multivariate analysis. Conclusions. Despite lower stage and lower PSA levels with time, we found no improvement in PSA recurrence rates over time. This may reflect lead-time bias in detecting PSA recurrence by the use of more sensitive PSA assays in recent years. UROLOGY 61: 736–741, 2003. © 2003, Elsevier Science Inc. T he Food and Drug Administration approved prostate-specific antigen (PSA) testing to mon- itor men with prostate cancer in 1986. It quickly became apparent that PSA measurement was also a valuable tool for the detection of early-stage pros- tate cancer. 1–3 By the late 1980s, PSA testing was widely used to screen asymptomatic men for pros- tate cancer, leading to dramatic increases in the incidence of new prostate cancer diagnoses and a dramatic decrease in the incidence of advanced dis- ease. 4–6 Combined with alterations in surgical technique that allowed improved potency preser- vation, 7 the rates of radical prostatectomy (RP) markedly increased. 4,8 Among men undergoing RP within the PSA era, there has been continued stage migration. 9 –12 However, whether this stage migra- tion within the PSA era has resulted in improved biochemical success after definitive therapy such as RP is unclear. 11–13 Moreover, PSA screening re- sulted in significant controversy as to whether it would result in patients being treated unnecessar- ily for small, clinically insignificant cancers. 14 We sought to determine whether in the PSA era stage and/or grade migration has occurred and This study was supported in part by the Department of Veterans Affairs and a Center for Prostate Disease Research grant from the United States Army Medical Research and Material Command. From the Department of Urology, University of California, Los Angeles, School of Medicine, Los Angeles, California; Department of Urology, Stanford University School of Medicine, Palo Alto, California; Department of Urology, Naval Medical Center, San Diego, California; Department of Urology, University of Califor- nia, San Francisco, School of Medicine, San Francisco, Califor- nia; Department of Surgery, Veterans Affairs Greater Los Angeles Health Care System, Los Angeles, California; Department of Bio- statistics, University of California, Los Angeles, Los Angeles, Cal- ifornia; and Division of Urology, Medical College of Georgia, Augusta, Georgia Reprint requests: Stephen J. Freedland, M.D., Department of Urology, University of California, Los Angeles, School of Medi- cine, 10833 Le Comte Avenue, 66-124 CHS, Box 951738, Los Angeles, CA 90095-1738 Submitted: October 1, 2002, accepted (with revisions): November 22, 2002 ADULT UROLOGY © 2003, ELSEVIER SCIENCE INC. 0090-4295/03/$30.00 736 ALL RIGHTS RESERVED doi:10.1016/S0090-4295(02)02526-8