Utilizing a large institutional dataset, the authors assessed the association between a prior history of cancer and important prostate cancer related outcomes following radical prostatectomy, including biochemical recurrence, metastasis, prostate cancer specific survival and overall survival. The authors identified a total of 24,814 patients in their cohort. A prior history of other malignancies was ascertained using patient-reported data from self-administered questionnaires. 7% of all patients endorsed such a history. As may be expected, these patients were older than those without a prior cancer history (median 66 and 64 years, respectively). However, there were no significant differences in prostate cancer risk, whether based on preoperative D’Amico risk groups, pathological T stage, or pathological Gleason score.
The risk of biochemical recurrence did not differ between patients with and without a prior history of another malignancy (hazard ratio 1.01, 95% CI 0.91-1.13). Similarly, the risk of metastasis was comparable (hazard ratio 0.9, 95% CI 0.7-1.1). However, prostate cancer related survival was significantly lower (hazard ratio 0.4, 95% CI 0.2-0.7) and the risk of all-cause mortality was significantly higher (HR 1.7, 95% CI 1.4-2.0). In absolute terms, the difference in prostate cancer mortality was quite small (2.5% vs 5.4%) whereas the difference in all-cause mortality was much larger (31.6% vs 6.6%).
The authors conclude that patients with prior malignancies have similar tumor characteristics to patients without such a history. While this is true, given the significant difference in mortality, driven by differences in non-prostate cancer mortality, we must consider whether the treatment of clinically localized prostate cancer, with it’s generally indolent course and significant potential for side effects offers a benefit to these patients with other life-limiting diseases.
Presented By: Pierre Tennstedt
Co-authors: Peter Klippenstein, Thorsten Schlomm, Burkhard Beyer, Raisa S. Pompe, Uwe Michl, Georg Salomon, Alexander Haese, Budäus Lars, Hans Heinzer, Hendrik Isbarn, Thomas Steuber, Hartwig Huland, Derya Tilki, Markus Graefen
Written by: Christopher J.D. Wallis, Urology Resident, University of Toronto, Twitter: @WallisCJD at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA