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Survival after radical prostatectomy for clinically localised prostate cancer: A population-based study

Roder M.A. Brasso K. Christensen I.J. Johansen J. Langkilde N.C. Hvarness H. Carlsson S. Jakobsen H. Borre M. Iversen P.

Comment by Henk van der Poel

In a national cohort from Denmark, prostate cancer mortality 10 year after prostatectomy was only 6.6% as compared to the 18% 18 year cancer specific mortality in the SPCG-4 study. The low median follow up of 4 years prohibits conclusions on longer term mortality but the low 0.1% 30days mortality after prostatectomy in a national cohort prove the relative safety of the procedure.

BJU International 2014 Apr;113(4):541-7.

Abstract

Objectives To describe survival and cause of death in a nationwide cohort of Danish patients with prostate cancer undergoing radical prostatectomy (RP). To describe risk factors associated with prostate cancer mortality.

Patiens and methods Observational study of 6489 men with localised prostate cancer treated with RP at six different hospitals in Denmark between 1995 and 2011. Survival was described using Kaplan-Meier estimates. Causes of death were obtained from the national registry and cross-checked with patient files. Cumulative incidence of death, any cause and prostate cancer-specific, was described using Nelson-Aalen estimates. Risk for prostate cancer death was analysed in a Cox multivariate regression model using the covariates: age, cT-category, PSA level and biopsy Gleason score.

Results The median follow-up was 4 years. During follow-up, 328 patients died, 109 (33.2%) from prostate cancer and 219 (66.8%) from other causes. Six patients (0.09%) died ≤30 days of RP. In multivariate analysis, cT-category was a predictor of prostate cancer death (P < 0.001). Compared with T1 disease, both cT2c (hazard ratio [HR] 2.2) and cT3 (HR 7.2) significantly increased the risk of prostate cancer death. For every doubling of PSA level the risk of prostate cancer death was increased by 34.8% (P < 0.001). Biopsy Gleason score 4 + 3 and ≥8 were associated with an increased risk of prostate cancer death compared with biopsy Gleason score ≤ 6 of 2.3 and 2.7 (P = 0.003), respectively. The cumulative hazard of all-cause and prostate cancer-specific mortality after 10 years was 15.4% (95% confide3nce interval [CI] 13.2-17.7) and 6.6% (95% CI 4.9-8.2) respectively.

Conclusions We present the first survival analysis of a complete, nationwide cohort of men undergoing RP for localised prostate cancer. The main limitation of the study was the relatively short follow-up. Interestingly, our national results are comparable to high-volume, single institution, single surgeon series.

© 2013 BJU International.

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