THE "NEW" PROSTATE CANCER INFOLINK

A newly published study in the journal Urology (“the Gold journal”) has reported data on risk of death from prostate cancer and other causes among > 3,000 contemporary patients diagnosed with non-metastatic prostate cancer in 2004-2005.

Through the use of data from the Cancer Registry of Norway and the Norwegian Prostate Cancer Registry (NoPCR), Aas et al. are able to provide a very detailed assessment of risk of death based on a wide range of factors, including age, clinical stage, ECOG score, Gleason grade group (from 1 to 5), type of treatment, and risk level at diagnosis — defined as follows:

• Low-risk: cT1-T2a and PSA <10 ng/mL and Gleason score < 7
• Intermediate-risk: all others
• High-risk localized: cT2c or PSA > 20 ng/ml or Gleason score  > 7
• High-risk locally advanced: cT3

The full text of this paper is available on line for those who are interested in digging into the details, so we will limit ourselves to reporting the major findings here:

• A total of 3,486 men were diagnosed with non-metastatic prostate cancer during the study period.
• 3,449 of those men had data that was appropriate for analysis, of whom
  • 915 (26 percent) were low risk
  • 1,065 (31 percent) were intermediate risk
  • 625 (18 percent) were high-risk localized
  • 844 (24 percent) were high-risk advanced
• Patients were all classified as having been treated initially by
  • Radical prostatectomy (n = 913; 26 percent)
  • Radiation therapy (n = 1,334; 39 percent)
  • No local therapy (n = 1,202; 35 percent)
• At 10 years of follow-up
  • 923 men (27 percent) had died in total
  • 296 men (9 percent) had died of prostate cancer
  • 627 men (18 percent) had died of other causes
• The probabilities of dying of prostate cancer within 10 years after diagnosis were
  • 1.7 percent among the low-risk patients
  • 4.5 percent among the intermediate-risk patients
  • 13.1 percent among the high-risk localized patients
  • 17.3 percent among the high-risk advanced patients
• The probabilities of dying of all causes within 10 years after diagnosis were
  • 14.1 percent among the low-risk patients
  • 20.9 percent among the intermediate-risk patients
  • 32.0 percent among the high-risk localized patients
  • 38.7 percent among the high-risk advanced patients

Basically this study confirms data from older, earlier studies, and shows that:

• Across all prostate cancer patients, the 10-year rate for overall mortality is almost three times as high as the 10-year rate for prostate cancer-specific mortality.
• Among patients with low-risk disease, the 10-year rate for overall mortality is about eight times as high as the 10-year rate for prostate cancer-specific mortality.
• Among men with high-risk disease (of both types), the 10-year rate for overall mortality is about twice as high as the 10-year rate for prostate cancer-specific mortality.

The authors conclude that

The 10-year [prostate cancer-specific mortality] and [overall mortality] rates for patients with nonmetastatic [prostate cancer] who were candidates for curative treatment diagnosed in Norway in 2004-2005 were 8.5% and 25.5%, respectively. Local treatment with curative intent was associated with a reduction in 10-year [prostate cancer-specific mortality], possibly with the greatest benefit for patients with high-risk tumors. Independent of allocation to either [radical prostatectomy or radiation therapy, the Gleason grade group] provides prognostic information supplementary to traditional risk grouping.

Filed under: Diagnosis, Living with Prostate Cancer, Management, Risk | Tagged: cancer-specific, mortality, Norway, overall, rate, risk |