Prostate Cancer Deaths Uncommon Even 30 Years After Surgery

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Daniel J. Lewinshtein, MD
Daniel J. Lewinshtein, MD

SAN FRANCISCO—Even 30 years after radical prostatectomy for prostate cancer, prostate cancer-specific and metastasis-free survival are excellent, researchers have concluded.

Investigators at Virginia Mason Medical Center in Seattle studied 1,004 consecutive patients who underwent radical prostatectomy for prostate cancer from 1954 to 1997. The cohort is one of the most mature radical prostatectomy series to be reported on to date, they noted.

Subjects had a mean age of 63.3 years and 75.3% of patients had clinical stage T2a disease or higher and a mean preoperative PSA level of 9.51 ng/mL.

Thirty years after surgery, the predicted disease-specific and metastasis-free survival was 76% and 81%, respectively, lead author Daniel J. Lewinshtein, MD, reported here today at the Genitourinary Cancers Symposium. On average, 78.5% of men will remain free of metastases and prostate cancer mortality 25 years after surgery, data showed.

The researchers limited to their analysis of biochemical recurrence to 20 years because their institution did not routinely use PSA testing until 1987. At 20 years, 35% of patients experienced PSA recurrence, which Dr. Lewinshtein described as suboptimal. The researchers defined as PSA rise of 0.2 ng/mL or rising, or initiation of radiotherapy or androgen deprivation therapy.

Of the patients who died, the median time to death was 19 years. In multivariate analyses, preoperative PSA, lymph node invasion, PSA relapse, and distant relapse were significant predictors of prostate cancer mortality.

Commenting on the findings, Howard Sandler, MD, Chairman of Radiation Oncology at Cedars-Sinai Medical Center in Los Angeles and chair of the symposium's program committee, pointed out that many of the men in the study underwent surgery prior to the advent of PSA screening, which has led to earlier detection of prostate tumors. Consequently, outcomes in these patients may be different from those diagnosed in the PSA era.

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