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Predictors of prostate cancer specific mortality after radical prostatectomy: 10 year oncologic outcomes from the Victorian Radical Prostatectomy Registry
Author(s) -
Bolton Damien M.,
Papa Nathan,
Ta Anthony D.,
Millar Jeremy,
Davidson AdeeJonathan,
Pedersen John,
Syme Rodney,
Patel Manish I.,
Giles Graham G.
Publication year - 2015
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.13112
Subject(s) - prostatectomy , prostate cancer , medicine , urology , general surgery , cancer
Purpose To identify the ability of multiple variables to predict prostate cancer specific mortality ( PCSM ) in a whole of population series of all radical prostatectomies ( RP ) performed in Victoria, Australia. Materials & Methods A total of 2154 open RP s were performed in Victoria between July 1995 and December 2000. Subjects without follow up data, Gleason grade, pathological stage were excluded as were those who had pT 4 disease or received neoadjuvant treatment. 1967 cases (91.3% of total) met the inclusion criteria for this study. Tumour characteristics were collated via a central registry. We used competing hazards regression models to investigate associations. Results At median follow up of 10.3 years pT stage of RP ( P < 0.001) and high Gleason score of the RP specimen ( P < 0.001 for ≥8 [Subhazard ratio ( SHR ) 11.19] and 4 + 3 = 7 [ SHR 7.10]) compared with Gleason score 6 disease were strong predictors of progression to PCSM . Gleason score 3 + 4 = 7 was not at this time a significant predictor of PCSM ( P = 0.08, SHR 1.84). Predictors of PCSM , independent of stage and grade, included rural residency ( P = 0.003), primary surgeon contributing less than 40 cases (low‐volume) to the VRPR ( P = 0.025) and the involvement of a trainee surgeon in the operation ( P = 0.031). Conclusion The significant prediction of PCSM by pT cancer stage, Gleason score and primary Gleason pattern at RP in this whole of population study suggests a need to avoid understaging/grading in the process of cancer diagnosis and active surveillance protocols. Multi‐modality therapy is likely to have a greater impact on PCSM in higher stage and Gleason grade disease. Identification of increased PCSM with rural residency and with involvement of a trainee urologist, and reduction in PCSM with higher surgeon volume all suggest potential for improved PC outcomes to be achieved with changes to surgical training and service delivery.