Premium
Survival after radical prostatectomy for clinically localised prostate cancer: a population‐based study
Author(s) -
Røder Martin Andreas,
Brasso Klaus,
Christensen Ib Jarle,
Johansen Jørgen,
Langkilde Niels Christian,
Hvarness Helle,
Carlsson Steen,
Jakobsen Henrik,
Borre Michael,
Iversen Peter
Publication year - 2014
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.12065
Subject(s) - prostate cancer , medicine , prostatectomy , hazard ratio , proportional hazards model , cancer , prostate , oncology , urology , cumulative incidence , cause of death , population , prostate biopsy , prostate specific antigen , gynecology , cohort , disease , confidence interval , environmental health
Objectives To describe survival and cause of death in a nationwide cohort of D anish patients with prostate cancer undergoing radical prostatectomy ( RP ). To describe risk factors associated with prostate cancer mortality.Patients and Methods Observational study of 6489 men with localised prostate cancer treated with RP at six different hospitals in D enmark between 1995 and 2011. Survival was described using K aplan–Meier estimates. Causes of death were obtained from the national registry and cross‐checked with patient files. Cumulative incidence of death, any cause and prostate cancer‐specific, was described using N elson– A alen estimates. Risk for prostate cancer death was analysed in a C ox multivariate regression model using the covariates: age, c T ‐category, PSA level and biopsy Gleason score.Results The median follow‐up was 4 years. During follow‐up, 328 patients died, 109 (33.2%) from prostate cancer and 219 (66.8%) from other causes. Six patients (0.09%) died ≤30 days of RP . In multivariate analysis, c T ‐category was a predictor of prostate cancer death ( P < 0.001). Compared with T 1 disease, both c T 2c (hazard ratio [ HR ] 2.2) and c T 3 ( HR 7.2) significantly increased the risk of prostate cancer death. For every doubling of PSA level the risk of prostate cancer death was increased by 34.8% ( P < 0.001). Biopsy G leason score 4 + 3 and ≥8 were associated with an increased risk of prostate cancer death compared with biopsy G leason score ≤ 6 of 2.3 and 2.7 ( P = 0.003), respectively. The cumulative hazard of all‐cause and prostate cancer‐specific mortality after 10 years was 15.4% (95% confide3nce interval [ CI ] 13.2–17.7) and 6.6% (95% CI 4.9–8.2) respectively.Conclusions We present the first survival analysis of a complete, nationwide cohort of men undergoing RP for localised prostate cancer. The main limitation of the study was the relatively short follow‐up. Interestingly, our national results are comparable to high‐volume, single institution, single surgeon series.