Prostate cancer-specific mortality after non-curative treatment of locally advanced disease


A new analysis of information from the Swedish national prostate cancer registry database and the Swedish cause of death register has confirmed the importance of aggressive, curative treatment of men with locally advanced prostate cancer.

Akre et al. wanted to assess the risk for prostate cancer-specific mortality among men initially diagnosed with locally advanced prostate cancer who could be  grouped into different prognostic categories and who had been managed with non-curative intent. To do this, the authors carried out a nationwide, registry-based cohort study based on information from the  the Swedish national prostate cancer registry.

The entire cohort included 14,908 men who were initially diagnosed with locally advanced prostate cancer. Of these, 14,908 men, 2,724 (18 percent) were excluded from the analysis because they were given treatment with curative intent. This left a total study population of 12,184 men who could be sorted into one of three categories:

  • Patients initially diagnosed with clinical stage T3NxMx disease
  • Patients initially diagnosed with clinical stage T4NxMx disease
  • Patients initially diagnosed with clinical stage T2NxM0 disease but with a serum PSA level between 50 and 99 ng/ml

These patients were all followed up for up to 11 years using the Swedish cause of death register and the cohort was assessed for cumulative incidence of prostate cancer-specific mortality stratified by age and clinical characteristics.

The key results are shown below.

  • Prostate cancer-specific mortality rates when categorized by Gleason scores were
    • 28 percent for patients with Gleason scores between 2 and 6
    • 41 percent for patients with Gleason scores of 7
    • 52 percent for patients with Gleason scores of 8
    • 64 percent for patients with Gleason score of 9 or 10
  • Prostate cancer was identified as the cause of death among 42 percent of men aged >85 years at time of diagnosis with locally advanced disease and Gleason scores of 8 to 10.
  • Prostate cancer was also a significant cause of death for men with locally advanced disease and a PSA < 4 ng/ml at diagnosis.

It should be noted that bone scan data were not available for 42 percent of the patient cohort. However, the results given above remained valid after exclusion of all patients with unknown metastasis status.

The authors conclude that (at least in Sweden) risk of prostate cancer-specific mortality within 8 years is high for men initially diagnosed with locally advanced prostate cancer, that many such men are in fact under-treated at initial diagnosis, and that greater efforts need to be made to investigate the potential of curative treatment for men diagnosed with locally advanced forms of prostate cancer.

The “New” Prostate Cancer InfoLink would note that at least in the USA, curative treatment of men initially diagnosed with locally advanced forms of prostate cancer has been much more aggressively pursued for many years — and has perhaps been best characterized by the long series of patients with T4N0 and N+ disease treated with a combination of radical prostatectomy and adjuvant hormone therapy at the Mayo Clinic. However, the need for better forms of treatment for men with locally advanced and micrometastatic disease is evident and well recognized.

One Response

  1. Interesting study! Treatment with curative intent reduced prostate cancer deaths by 73% in patients with advanced disease. Maybe the USPSTF should reconsider …

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