Patients undergoing radical prostatectomy have a better survival than the background population

INTRODUCTION

The objective of this study was to investigate standardised relative survival and mortality ratio for patients undergoing radical prostatectomy for localized prostate cancer at our institution.

MATERIAL AND METHODS

Between 1995 and 2010, a total of 1,350 consecutive patients underwent radical prostatectomy. Patients were followed prospectively per protocol. No patients were lost to follow-up. Overall and cause-specific survival were described using Kaplan-Meier plots. Standardized relative survival and mortality ratio were calculated based on expected survival in the age-matched Danish population using the methods and macros described by Dickmann. The country-specific population mortality rates used for calculation of the expected survival were based on data from The Human Mortality Database.

RESULTS

The median follow-up was 3.4 years (range: 0-14.3 years). A total of 59 (4.4%) patients died during follow-up. In all, 17 (1.3%) patients died of prostate cancer. The estimated ten-year overall survival was 89.3%. The cancer-specific survival was estimated to 96.6% after ten years. Relative survival was 1.04 after five years and 1.14 after ten years. The standardized mortality ratio, i.e. observed mortality/expected mortality, was 0.61 and 0.39 at five and ten years, respectively.

CONCLUSION

The overall and cancer-specific ten-year survival in a consecutive series of patients in a non-screened Danish population is ≥ 89%. The survival and mortality ratio is significantly better than expected in the age-matched background population. This finding is likely explained by selection bias. Although the results indicate an excellent outcome in terms of cancer control, the efficacy of prostatectomy for localized prostate cancer remains at debate.

FUNDING

not relevant.

TRIAL REGISTRATION

not relevant.

Radical prostatectomy in clinically localized high-risk prostate cancer: outcome of 231 consecutive patients

OBJECTIVE

The optimal therapeutic strategy for high-risk localized prostate cancer (PCa) is controversial. Supported by randomized trials, the combination of external beam radiation therapy (EBRT) and endocrine therapy (ET) is advocated by many, while radical prostatectomy (RP) is regarded as primary therapy by others. This study examined the outcome for high-risk localized PCa patients treated with RP.

MATERIAL AND METHODS

Of 1300 patients who underwent RP, 231 were identified as high-risk. Patients were followed for biochemical recurrence (BCR) (defined as prostate-specific antigen ≥ 0.2 ng/ml), metastatic disease and survival. Excluding node-positive patients, none of the patients received adjuvant therapy before BCR was confirmed. Univariate and multivariate analysis was performed with Kaplan-Meier and Cox proportional hazard models.

RESULTS

Median follow-up was 4.4 years (range:0.1-14.9). The estimated 10-year biochemical recurrence-free survival was 49%, 10-year metastasis-free survival was 81%, 10-year overall survival was 84% and estimated cause-specific survival after 10 years was 90%. In multivariate analysis extracapsular extension, seminal vesicle invasion and young age were significant predictors of BCR.

CONCLUSION

The results confirm that a significant proportion of patients with high-risk PCa remain biochemically diseasefree and without a need for ET following RP as the primary and only treatment. A large randomized study of RP as primary therapeutic strategy versus the combination of EBRT and ET in patients with high-risk localized PCa seems warranted.

[Early complications following open radical prostatectomy]

INTRODUCTION

Radical prostatectomy has been offered as curative treatment for localized prostate cancer at Rigshospitalet since August 1995. We here report on postoperative complications in 719 patients operated during the 12-year-period from August 1995 to August 2007 with special emphasis on developments over time.

MATERIAL AND METHODS

A retrospective review.

RESULTS

Median age at surgery was 63 years with a significant increase from 61 to 64 during the 12-year-period. We found no change in clinical preoperative T-category, whereas the median pre-treatment PSA decreased significantly. This reflects increased surgical experience and an optimized postoperative course. Significant reductions in operating time, need for blood transfusions, and length of hospitalisation were recorded. One or more complications were registered in 164 patients (22.8%); severe complications occurred in eight patients (1,1%). One patient died within 30 days after surgery.

CONCLUSION

Our results demonstrate that radical prostatectomy can be performed with a minimal mortality and an acceptable morbidity.