National Long-term Survival Estimates After Radical Prostatectomy for Prostate Cancer

Abstract

ObjectiveTo examine survival and disease control outcomes, including metastasis-related survival outcomes, in a large contemporary cohort of patients undergoing radical prostatectomy for localized prostate cancer. MethodsWe conducted a retrospective study of men with localized prostate cancer treated with radical prostatectomy from 2005-2015 with follow up through 2019 in the Veterans Health Administration. We defined biochemical recurrence (BCR) as a PSA ≥0.2 ng/mL. We used a validated natural language processing encoded dataset to identify incident metastatic prostate cancer. We estimated overall survival from time of surgery, time of BCR, and time of first metastasis using the Kaplan-Meier method. We then estimated time from surgery to BCR, BCR to metastatic disease, and prostate-cancer specific survival from various time points using cumulative incidence considering competing risk of death. ResultsOf 21,992 men undergoing radical prostatectomy, we identified 5,951 (27%) who developed biochemical recurrence (BCR). Of men with BCR, 677 (11%) developed metastases. We estimated the 10-year cumulative incidence of BCR and metastases after BCR were 28% and 20%, respectively. Median overall survival after BCR was 14 years, with 10-year survival of 70%. From the time of metastasis, median overall survival approached 7 years, with 10-year overall survival of 34%. Prostate cancer-specific survival for the entire cohort at 10 years was 94%. ConclusionsIn this large contemporary national cohort, survival for men with biochemically-recurrent prostate cancer is longer than historical cohorts. When counseling patients and designing clinical studies, these updated estimates may serve as more reliable reflections of current outcomes.