Does age affect the outcomes of men after radical prostatectomy for high-risk prostate cancer? Does a long post-operative cancer specific survival make a difference in outcomes in such patients? A major new study suggests that both the age of the patient and the time survived since the operation have a significant impact in terms of cause of death. In practical terms this means that, for young men with high-risk prostate cancer, doctors may have to re-evaluate long-term clinical priorities with increasing time since surgery. This study is being presented at the European Association of Urology conference in Madrid.
These conclusions are based on the efforts of a multi-institutional international collaboration (the EMPACT group) developed to record long-term outcomes of patients classified as having "high-risk" prostate cancer (see below for definition*) and treated with radical prostatectomy. The study team was able to compile a database of 7650 patients from 14 different tertiary care centres in Italy, the USA, France, Belgium, Germany, Poland, Switzerland, and the Netherlands. Within this population, they were able to identify 612 patients treated with radical prostatectomy (RP) over a 26 year period, from 1987 to 2013 who were under the age of 60. The median follow up time was of 89 months. For each patient the number of cancer-specific related deaths (CSM) were recorded, and compared with the number of non-cancer related deaths (OCM).
They found that in patients younger than 60 years of age, there was a higher probability of dying of prostate cancer than of other causes in the first 10 years after a radical prostatectomy operation. However, after that initial period, cancer deaths diminish and other causes of death become more significant. This means that with increasing time since radical prostatectomy, care for these patients should gradually shift from prioritising prostate cancer towards prioritising other health risks (such as heart disease), even though regular urological check-ups should continue.
Commenting, lead author Dr Marco Bianchi (Ospedale San Raffaele, Milano, Italy) said:
"These results confirm that if you are under 60 when you undergo a radical prostatectomy you need close follow-up, concentrating on possible cancer recurrence for the first 10 years. After that time, patients should worry less about prostate cancer and priorities may need to shift to other health risks, even though regular urological check-ups should be continued.
What this means in practice is that each patient needs close, personalised regular monitoring, where the urologist should not focus only on prostate cancer features, but also on the general health status of the patients. This is particularly important especially with increasing time after surgery, since new comorbidities, such heart disease, may develop and become a more immediate risk to the patient's health".
*High risk was defined according to the D'Amico criteria (PSA>20 and/or cT3 or higher and/or biopsy Gleason sum 8-10).