After 10 years, risk of prostate cancer-specific mortality lower for high-risk patients

A paper presented at the annual meeting of the European Association of Urology (EAU) suggests that high-risk prostate cancer patients < 60 years of age at the time of radical prostatectomy are more likely to die from their cancer than from other causes during the first 10 years after their surgery. But after that, other causes of death become more likely. A media release from the EAU, along with the abstract of the paper by Bianchi et al., is available on line.

The study was based on a retrospective analysis of data from patients treated at centers in several different countries (the USA, Italy, France, Belgium, Germany, Poland, Switzerland, and the Netherlands). Here is a summary of the key study data:

  • The total study database comprised 7,650 patients
  • Data were available for 612 high-risk patients, all aged between 39 and < 60 years, and all receiving first-line treatment with radical prostatectomy between 1987 and 2013.
  • High-risk disease was defined by the standard NCCN criteria (any one or more of a PSA level > 20 ng/m, or a clinical stage of T3 or higher, or a biopsy Gleason score of 8 to 10).
  • Mean age at diagnosis was 56 years (median, 57 years).
  • Mean follow-up time was 90 months (median, 89 months).
  • During the study follow-up period
    • 57/612 patients (9.3 percent) died of prostate cancer.
    • 37/612 patients (6.0 percent) died of of other causes.
  • Actuarial prostate cancer-specific survival rates were
    • 93.9 percent at 5 years
    • 87.0 percent at 10 years
    • 82.2 percent at 15 years
  • Actuarial overall survival rates were
    • 91.0 percent at 5 years
    • 82.1 percent at 10 years
    • 69.6 percent at 15 years
  • Among patients who survived for 5 years post-surgery
    • Probability of dying from prostate cancer was 7.3 percent
    • Probability of dying from other causes was 2.6 percent
  • Among patients who survived for 8 years post-surgery
    • Probability of dying from prostate cancer was 6.7 percent
    • Probability of dying from other causes was 5.8 percent
  • Among patients who survived for 10 years post-surgery
    • Probability of dying from prostate cancer was 5.3 percent
    • Probability of dying from other causes was 9.9 percent
  • Significant factors predicting risk for prostate cancer-specific death included year of surgery, Gleason score, pathological T stage, surgical margin status, and lymph-node invasion.

Quoted in the EAU media release, Dr. Bianchi stated that:

These results confirm that if you are under 60 when you undergo a radical prostatectomy you need close follow-up, concentrating on possible cancer recurrence for the first 10 years. After that time, patients should worry less about prostate cancer and priorities may need to shift to other health risks, even though regular urological check-ups should be continued.

What this means in practice is that each patient needs close, personalized regular monitoring, where the urologist should not focus only on prostate cancer features, but also on the general health status of the patients. This is particularly important, especially with increasing time after surgery, since new comorbidities, such [as] heart disease, may develop and become a more immediate risk to the patient’s health.

What is perhaps also interesting about this study is the rates of prostate cancer-specific mortality at 10 and 15 years among this cohort of > 600 high-risk patients. Whether this reflects some form of selection bias is difficult to ascertain on the basis of the data currently available.

The study was not designed to provide information about such matters as follow-up treatments or side effects of surgery and other treatments. It is perhaps unsurprising that high-risk patients who survive for 10 years after initial surgery become less likely to die of prostate cancer than of other causes. However, it is helpful to have data documenting the actual risk levels (at least for this cohort of men).

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