996 NATION-WIDE ANALYSIS OF SURVIVAL AFTER RADICAL PROSTATECTOMY FOR CLINICALLY LOCALIZED PROSTATE CANCER IN DENMARK 1995-2011

Abstract

INTRODUCTION AND OBJECTIVES: PSA-screening for prostate cancer (PCa) has never been recommended in Denmark. Radical prostatectomy (RP) for clinically localized PCa was introduced in 1995. The objective of study was to describe survival after RP in a nationwide cohort of Danish PCa patients. METHODS: Prospective observational study of 6489 men with localized PCa treated with RP at 6 different hospitals in Denmark between 1995 and 2011. Survival was described using Kaplan-Meier estimates. Causes of death were obtained in national registry and cross-checked with patient files. Cumulative incidence of death; any cause and PCa-specific was described using Nelson-Aalen estimates. Risk for PCa death was analyzed in a Cox multivariate regression model using covariates age, cT-category, PSA and biopsy Gleason score (GS). RESULTS: Median follow-up was 4 years. During follow-up, 328 patients died, 109 (33.2%) of PCa and 219 (66.8%) of other causes. Six patients (0.09%) died within 30 days of surgery. In multivariate analysis, cT-category was a predictor of PCa death (p .001). Compared to T1 disease, both cT2c (HR 2.2) and cT3 (HR 7.2) significantly increased the risk of PCa death. For every doubling of PSA the risk of PCa death was increased by 34.8% (p 0.001). Biopsy GS 4 3 and 8 were associated with an increased risk of PCa death compared to biopsy GS 6 of 2.3 and 2.7 (p 0.003), respectively. The cumulative incidence of any-cause mortality after 10 years was 15.4% (95% CI:13.2-17.7) and 6.6% (95% CI:4.9-8.2) for PCa mortality. CONCLUSIONS: Our results seem comparable to high-volume, single institution, single surgeon series u even in a country where PCa are primarily clinically detected and patients are managed by small volume, multi-surgeon institutions. The true benefit of RP in localized PCa compared other treatment strategies remains controversial.