AUA 2017: Do Sicker People Have Worse Prostate Cancer-Specific Outcomes After Radical Prostatectomy? Results from SEARCH

Boston, MA (UroToday.com) Lauren Howard presented the VA cohort (SEARCH) results assessing whether sicker patients have worse prostate cancer-specific outcomes after radical prostatectomy at this morning’s prostate cancer detection and screening podium session at the 2017 AUA Annual meeting. Certainly patients with greater comorbidity are at risk for worse all-cause mortality, however whether this is also true for prostate cancer specific outcomes after definitive treatment is not established.

To conduct this study, the authors queried the retrospective SEARCH database using American Society of Anesthesiology (ASA) score at the time of prostatectomy as a surrogate for comorbidity (ASA 1-2 vs 3-4). There were 3,102 men who underwent radical prostatectomy between 1992 and 2015, including 54% men with ASA score 3-4. These men tended to be older, had more recent radical prostatectomy, higher BMI, and higher biopsy Gleason score when compared to men with ASA 1-2. Not surprisingly, men in the higher ASA group had an increased risk of all-cause mortality compared to men in the lower ASA group (HR 1.59, p<0.001). Importantly, there was no increased risk of biochemical recurrence (p=0.23), metastasis (p=0.22), or prostate cancer specific mortality (p=0.83). The strength of this study is the large sample size with long follow-up and granular variable details to allow analyses of long-term prostate cancer specific outcomes.

In summary, men who underwent radical prostatectomy for prostate cancer with worse baseline health had a higher risk of all-cause mortality but did not have higher risk of the adverse prostate cancer specific outcomes of biochemical recurrence, metastasis, or death from prostate cancer. This work is important and further highlights that a life-expectancy calculation/discussion is necessary when discussing potential treatment options with newly diagnosed prostate cancer patients.

Speaker: Lauren Howard, Durham VA Medical Center, Durham, NC, USA
Co-Authors: Anna Teeter, Xizi Sun, William Aronson, Christopher Kane, Christopher Amling, Matthew Cooperberg, Martha Terris, Stephen Freedland

Written By: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre
Twitter: @zklaassen_md

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA
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