585 PROSTATE CANCER-SPECIFIC SURVIVAL THIRTY YEARS AFTER RADICAL PROSTATECTOMY

Abstract

You have accessJournal of UrologyProstate Cancer: Localized III1 Apr 2010585 PROSTATE CANCER-SPECIFIC SURVIVAL THIRTY YEARS AFTER RADICAL PROSTATECTOMY Dan Lewinshtein, Brandon Teng, Toru Okura, Debbie Sparks, Ashley Valencia, Robert Gibbons, and Christopher Porter Dan LewinshteinDan Lewinshtein More articles by this author , Brandon TengBrandon Teng More articles by this author , Toru OkuraToru Okura More articles by this author , Debbie SparksDebbie Sparks More articles by this author , Ashley ValenciaAshley Valencia More articles by this author , Robert GibbonsRobert Gibbons More articles by this author , and Christopher PorterChristopher Porter More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.857AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We report on 30-year cancer control and survival outcomes after radical prostatectomy in a single center series of patients treated during a 43-year period. METHODS Between 1954 and 1997, 1004 consecutive patients underwent radical prostatectomy at Virginia Mason Medical Center in Seattle, Washington. Kaplan-Meier 30-year probabilities of prostate-cancer (PC) specific, overall, PSA progression-free, local and distant progression-free survival were determined. Univariate and multivariate Cox regression models addressed PC-specific mortality. RESULTS Mean age was 63.3 years. 75.3% of patients were clinical stage T2a or higher. Mean pre-op PSA was 9.51ng/ml. 18.2% of patients had a biopsy Gleason sum 7 or higher. 30-year PC-specific survival, overall survival, PSA progression-free survival, local and distant progression-free survival were 76%, 4% 45%, 89%, and 81%, respectively. Median times to local progression, distant progression, and PC-specific death were not reached during follow up. Median time to overall death was 19 years. In univariate analyses, pre-op PSA, pathological stage, pathological Gleason sum, positive surgical margin, lymph-node invasion (LNI), PSA relapse, local relapse and distant relapse represented statistically significant predictors of PC-specific mortality (all p<0.001). In multivariate analyses only PSA relapse, local relapse and distant relapse remained significant (all p<0.02). CONCLUSIONS This is one of the most mature radical prostatectomy series. It demonstrates that long-term biochemical cancer control outcomes after radical prostatectomy might be suboptimal. However, local and distant control outcomes are excellent, and cancer specific mortality is minimal even 30 years after surgery. Finally, only relapse was a significant predictor of PC-death, and thus it is difficult to ascertain who will die of their cancer at time of diagnosis. Table 1. Univariate and multivariate risk ratios for prostate cancer-specific survival. (multivariate included only if univariate significant) Variable Univariate analysis RR (p value) Multivariate analysis (p value) Age 1.01 (0.782) Comorbidity (one or more vs. none) 0.705 (0.555) Pre-operative PSA 1.04 (<0.001) 1.04 (0.154) Surgical procedure: Retropubic vs perineal 1.08 (0.774) Lymphadenectomy 0.93 (0.810) Pathological stage (0.001) (0.182) pT2B/T2C vs T2A 0.782 (0.636) 0.08 (0.07) pT3/T4 vs T2A 4.17 (0.001) 0.19 (0.168) Path gleason sum (<0.001) (0.266) 6 vs 2-5 2.15 (0.057) 0.00 (0.997) 7 vs 2-5 2.71 (<0.03) 1.78 (0.665) 8-10 vs 2-5 6.8 (<0.001) 6.90 (0.130) Positive margin 2.66 (<0.001) (0.252) Gland volume 1.01 (0.382) Lymph node invasion 13.34 (<0.001) 4.04 (0.331) BCR 35.91 (<0.001) 2.29 (<0.02) Local recurrence 3.28 (<0.001) 2.76 (<0.02) Distant recurrence 27.35 (<0.001) 48.4 (<0.001) Radiotherapy after surgery 1.774 (0.339) Seattle, WA© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e229-e230 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dan Lewinshtein More articles by this author Brandon Teng More articles by this author Toru Okura More articles by this author Debbie Sparks More articles by this author Ashley Valencia More articles by this author Robert Gibbons More articles by this author Christopher Porter More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...