Prostate Cancer

Surgical Outcomes for Prostate Cancer at Mayo Clinic in Minnesota

The Department of Urology at Mayo Clinic in Rochester has been tracking the short- and long-term results of prostate cancer surgery since 1966. The data registry is continually updated by actively following patients over time, and currently has more than 15,000 men entered. Analysis of the data shows changing trends in both the early diagnosis of prostate cancer and the long-term survival of patients.

Improvement in Early Detection
The introduction of the prostate-specific antigen (PSA) test in the 1980s has tremendously improved the early detection of prostate cancer, making more men eligible for surgical treatment by radical prostatectomy (removal of the prostate gland). Prior to the PSA test, the best means of screening for prostate cancer was the digital rectal exam (DRE) in which a physician examines the gland through the wall of the rectum. The PSA test is more likely to detect cancer before there is any sign of it in the DRE and before it spreads beyond the gland. Cancer detected by DRE (any enlargements of the gland that are felt by the physician) is more likely to have spread beyond the prostate.

As a result of early detection:

• The median age for men undergoing prostate cancer surgery has dropped from 67 in 1966 to 63 in 1998. This means over half of the men who have surgery are younger than 63 years old.
• In 1987, two percent of the patients who had surgery had the cancer detected before it could be diagnosed with a DRE. In 1998, about 50 percent of the patients were diagnosed before DRE detection.
• In 1987, only 42 percent of patients had cancer confined to the organ at the time of surgery while in 1998 almost 80 percent of patients had cancer confined to the organ at the time of surgery.

Improved Survival After Surgery
Of the men who had prostate cancer treated at the Mayo Clinic by radical prostatectomy using the retropubic approach (the most common type of prostatectomy) between 1987 and 2002, not a single death from prostate cancer occurred among those whose cancer was detected by PSA and whose cancer had not spread beyond the prostate. (Only 1 percent of these men were lost to follow up). Only 20 percent of men whose cancer had spread beyond the organ died of their disease within 15 years of surgery, indicating the positive impact of the surgery on the progression of the cancer.

Improved Surgical Side Effects
The data on the table below shows improvement over time for major complications such as rectal injury, clots of the heart or lungs, and need for blood transfusion.

In addition, fewer patients report significant stress incontinence and fewer patients require surgical correction of incontinence. In fact, 90 percent are continent. Only 0.1 percent require an artificial genitourinary sphincter.