Risk of death within 30 days of radical prostatectomy: a modern cohort study

Historically (by which we mean back in the 1980s and earlier) there was a well-recognized and significant risk of mortality associated with radical prostatectomy (RP), which was seen at that time as a difficult and “bloody” procedure with a well-understood series of risks for significant complications. The risk of mortality directly associated with the procedure at that time was variously reported as being between 0.25 and 1.25 percent — depending in large extent on the experience of the surgeon and the capabilities of the institution where the procedure was being performed.

In the past 30 years, however, with improvements in surgical technique, the increasing use of laparoscopic surgical processes, and the earlier diagnosis of the majority of prostate cancer patients resulting from PSA testing, the short-term risk for mortality associated with this procedure has declined.

Carlsson et al. have recently reported data on the 30-day mortality post-RP for the entire Swedish nation between 1997 and 2002, and these data clearly support the perception that the risk of mortality associated with RP is now minimal at worst and bordering on the non-existent.

As in most other Western nations, the apparent incidence of prostate cancer has increased significantly over the past 15 years, as as has the number of men receiving treatment with curative intent for early stage disease, and RP is commonly performed at large high-volume centers and out in the community setting.

This nationwide population-based study included all men of ≤ 70 years of age, diagnosed with localized prostate cancer (clinical stage T1-2, PSA < 20 ng/ml) who underwent RP in Sweden between 1997 and 2002 identifiable through the National Prostate Cancer Register (NPCR). Deaths within 30 days of RP were identified through linkage between the follow-up study of the NPCR and the Regional Population Registers. The causes of death in the death certificates were compared with data from the hospitals concerned. In addition, to validate the results, a record linkage between the Inpatient Register and the National Population Register was also performed.

The core results of this study were as follows:

  • The number of RPs performed in each year of the study increased over time.
  • A total of 3,700 RPs were performed during the 6 years of the study
  • Only four deaths occurred within the first 30 days after RP, yielding a 30-day mortality rate of 0.11 percent ( about one death among each 1,000 surgeries).
  • These four deaths occurred at three different types of hospital and were all probably related to the RP.

The authors conclude that this nationwide study provides further substantive evidence of the very low preioperative mortality rate of radical prostatectomy today.

There is clearly still a greater risk for mortality in older patients with one or more comorbidities, which increases the necessity for great care in determining whether surgery is an appropriate treatment option, particularly in the case of patients of ≥ 75 years of age, in whom their life expectancy should be a key factor in determining whether any form of invasive treatment is appropriate by comparison with expectant management techniques.

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