THE "NEW" PROSTATE CANCER INFOLINK

Two papers to be presented by Lewinshtein and Porter at the Genitourinary Cancers Symposium (starting tomorrow in San Francisco) offer some interesting insights on patients initially treated as long ago as the mid-1950s.

These two papers are based on a series of 1,004 consecutive patients treated by open radical prostatectomy (RP) at the Virginia Mason Medical Center in Seattle, Washington starting in 1954 and followed through to 1997. So remember that a large percentage of these patients were diagnosed with prostate cancer well before anyone had started to use the PSA test to detect (or monitor progression of) prostate cancer! Indeed, for the very early patients there would have been no Gleason grades, because Gleason grading hadn’t been developed either!

In the first of these two papers, the authors set out to assess the 30-year cancer control and overall survival of this single-institution series of RP patients. Their data show the following:

• The average (mean) age of the patients at the time of RP was 63.3 years
• 756/1,004 patients (75.3 percent) were clinical stage T2a or higher.
• In the patients for whom PSA data were available, the mean pre-surgical PSA level was 9.5 ng/ml.
• In the patients for whom Gleason grades and scores were available, 18.2 percent had Gleason scores of ≥ 7.
• The 30-year prostate cancer-specific survival rate was 76 percent.
• The 30-year overall survival rate was 4 percent. (This is not exactly surprising if the average age of the patients at diagnosis was 63.3: 63.3 + 30 = 93.3!)
• The 30-year PSA progression-free survival rate was 45 percent.
• The 30-year local progression-free survival rate was 89 percent.
• The 30-year distant progression-free survival rate was 81 percent.
• The median time from diagnosis to overall mortality was 19 years.
• Median times to local progression, distant progression, and prostate cancer-specific mortality were not reached.

What these data from one of the most mature series of prostate cancer patients appears to show is that: (a) prostate cancer-specific mortality is minimal even 30 years after surgery and (b) that prostate cancer-specific mortality is minimal even though the rate of biochemical recurrence may seem to be less than optimal!

In the second set of data from this series, the same authors looked at the percentage of patients who went on to get metastatic prostate cancer.

There were only 99 such patients among the original 1,004 (9.9 percent). In this subset of 99 patients, the authors showed the following:

• Median time from surgery to identification of metastases was 6.7 years.
• Average (mean) time from biochemical recurrence to metastases was 5.0 years.
• 77/99 patients (77.7 percent) had died
• 55/77 (71 percent) died of prostate cancer
• 22/77 patients died of other causes, including cardiovascular disease (8/77 or 10.4 percent), pulmonary disease (4/77 or 5.2 percent) and lung cancer (3/77 or 4 percent).

The authors conclude that, in this series of RP patients, followed over a total period of 43 years, less than 10 percent of patients went on to have metastases and nearly 30 percent died of causes other than prostate cancer. They state in their conclusion that, it is important for patients with metastatic disease to be appropriately monitored by physicians whose primary interest is not in prostate cancer, since many such patients are going to be at significant risk for co-morbid conditions that may cause their death.

Filed under: Living with Prostate Cancer, Management, Treatment Tagged: | long-term, metastasis, outcomes, radical prostatectomy