Editor's Commentary - Predicting 15-year prostate cancer specific mortality after radical prostatectomy

BERKELEY, CA (UroToday.com) - Dr. Scott Eggener and colleagues from four academic medical centers presented their long-term prostate cancer (CaP) specific mortality (PCSM) after radical prostatectomy (RP) in the March 2011 issue of the Journal of Urology.

In total, 11,521 patients with localized CaP treated with RP at Memorial Sloan-Kettering Cancer Center, Cleveland Clinic, University of Michigan, and Baylor College of Medicine between 1987 and 2005 were included in the analysis. Pathology was performed at each institution, but tertiary Gleason scores were not assessed. Of 788 men who received postoperative radiotherapy, 756 had a detectable PSA pre-radiotherapy. In addition, 1,045 patients received androgen deprivation therapy (9%) for biochemical or clinical progression.

Death attributable to CaP was determined in 338 men and death from other causes in 1,204. The 15-year PCSM for the modeling and validation cohorts were 7% and 4% and the 15-year all cause mortality was 33% and 16%, respectively. They also calculated the data after 1995, when the influence of stage migration effect had stabilized and found overall 108 PCSM events (32%) occurred. Variables significantly associated with PCSM in multivariate analysis included primary and secondary Gleason grade 4-5, seminal vesicle invasion, and surgery year. For patients with Gleason score 6 or less, the PCSM risk at 15 and 20 years was 1.2% or less. The risk of death from competing causes was higher, regardless of age at diagnosis. However, this was in contrast to men with pathologic Gleason score 8-10 tumors, who had a PCSM risk of >31% at 15-20 years; substantially higher than the risk of death from competing causes even at age 70 years or greater. The investigators did not find differences in 15-year PCSM between Gleason 3+4 and 4+3. Analysis of pathologic stage revealed 0.8-1.5% PCSM risk at 15-20 years for organ-confined disease, which increased to 22-42% in patients with seminal vesicle invasion or lymph node metastasis. This was particularly true in men age 69 or less. Pathologic isolated extraprostatic extension only indicated a PSCM risk on men under age 70 of 2.9-7.0% at 15-20 years. This compared to 6.6-24% for competing causes. For men with organ-confined, pathological Gleason score 6 cancer, only 3 deaths occurred among 9,557 patients.

Eggener SE, Scardino PT, Walsh PC, Han M, Partin AW, Trock BJ, Feng Z, Wood DP, Eastham JA, Yossepowitch O, Rabah DM, Kattan MW, Yu C, Klein EA, Stephenson AJ


J Urol. 2011 Mar;185(3):869-75

PubMed Abstract
PMID: 21239008

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