ASCO GU 2008 - Prostate Cancer-Specific Mortality After Radical Prostatectomy In The Prostate-Specific Antigen Era

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Men's health;  Clinical Trials / Drug Trials
Article Date: 24 Feb 2008 - 0:00 PDT

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UroToday.com - The long-term risk of CaP specific mortality after RP is poorly defined. The diagnostic lead-time using a PSA screening interval of 4 years is 11 years. This study developed a nomogram from 6,398 patients at MSKCC and Baylor from 1987-2005. A validation cohort of 4,103 patients from the Cleveland Clinic was also applied. The modeling and validation cohort had very similar patient characteristics.

PCSM at 15 years was 12% and the all-cause mortality (ACM) was 38%. Assessing the groups by the D'Amico risk criteria, good risk patients had a long-term risk of PCSM of 2%, but high-risk men had a 19% chance of PCSM. This compared to 31% ACM. Death from other causes exceeds the risk of death from CaP for all risk groups. In the multivariate competing risk regression analysis, PSA velocity was not significant. The year of surgery was significant predictor of PCSM; likely to advances in surgical technique and increased screen detected cancers. The concordance index of the nomogram is 0.82. PSAV and BMI did not substantially improve the predictive ability of the nomogram. 13% of patients had predicted 15 year PCSM >5 %. He concluded the long-term risk of PCSM after RP in the PSA era is low, even for those with adverse clinical parameters. This may partially reflect the low lethality of screen detected CaP. In a comment, Dr. D'Amico cautioned that the nomogram is based upon a mean patient follow-up of only 4 years.

Presented by A. J. Stephenson at the American Society of Clinical Oncology (ASCO) - 2008 Genitourinary Cancers Symposium - A Multidisciplinary Approach - February 14-16, 2008 San Francisco, California, USA

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS Professor & Chairman Department of Urology University of California, Davis, School of Medicine Sacramento, CA

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