Prostate Cancer-specific Mortality After Radical Prostatectomy For Patients Treated In The Prostate-specific Antigen Era

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Cancer / Oncology
Article Date: 01 Nov 2009 - 0:00 PDT

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UroToday.com - In the online edition of the Journal of Clinical Oncology, a multi-institutional study reports on prostate cancer (CaP)-specific mortality after radical prostatectomy (RP) treated since the introduction of PSA.

The study sought to establish a predictive nomogram and modeled the nomogram on 6,398 patients treated with RP at Baylor and MSKCC between 1987 and 2005. External validation of the nomogram was performed on 4,103 patients treated at the Cleveland Clinic and 2,176 patients treated at the University of Michigan. Patients were observed for disease recurrence and death was attributed to CaP using death certificates.

In the modeling cohort, 117 patients died from CaP and 343 died from competing causes over a median follow-up of 48 months. The 15-year prostate cancer specific mortality was 12% and the all-cause mortality was 38%. Results were similar in the validation cohort. Patients lost to follow-up at 5, 10, and 15 years were 17%, 24%, and 16%, respectively. The 5-year PSA progression-free probability (PFP) derived from a nomogram was significantly associated with PCSM. In the most favorable quartile, the 15-year PCSM was 5% compared with 38% in the lowest quartile. When analyzed by previously validated risk groups for PSA recurrence, the 15-year PCSM was 2%, 10% and 19% for patients classified as good risk, intermediate risk, and high risk. Multivariable analysis showed that primary and secondary biopsy Gleason grade 4 and 5 and increasing PSA were associated with PCSM. Patients undergoing RP in more recent times had an improved prognosis. PSA velocity was not associated with PCSM. A nomogram predicting PCSM at 10 and 15 years was constructed and adjusted for the year of surgery.

The externally validated concordance index was 0.82 and predictions closely approximated the actual outcome. The model assumes that patients are treated in the year 2005. Considering all 11,649 patients in both cohorts with complete data, only 1,980 (17%) had a predicted 15-year PCSM greater than 5% and 467(4%) had a probability greater than 30%. Considering the 7,403 patients treated since 1998, 296 (4%) had a probability of PCSM >5% and 37 (0.5%) had a predicted risk greater than 30%.

Stephenson AJ, Kattan MW, Eastham JA, Bianco FJ Jr, Yossepowitch O, Vickers AJ, Klein EA, Wood DP, Scardino PT
J Clin Oncol. 2009 Jul 27. Epub ahead of print.
doi:10.1200/JCO.2008.18.2501

Written by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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