Most Deaths After Radical Prostatectomy Not Due to Prostate Cancer

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Men who undergo radical prostatectomy (RP) for prostate cancer (PCa) are much more likely to die from cardiovascular disease (CVD) and other cancers than from PCa, according to researchers.

An analysis of data from 120,392 men undergoing RP for clinically localized PCa showed that the 15-year PCa-specific mortality (PCSM) was 5.3% and the 15-year non-PCa mortality was 30.6%, according to a report published online ahead of print in Prostate Cancer and Prostatic Diseases.

In addition, at 15 years after surgery, mortality due to CVD was 11%, other cancers, 9.1%, and other causes, 10.5%. Among men aged 65 years and older, 15-year PCSM was 6% and 15-year non-PCa mortality was 40.8%.

For the study, Sergey Shikanov, MD, and colleagues at the University of Chicago used data from the Surveillance, Epidemiology, and End Results (SEER) database. The cohort had a median age of 63 years. Of the 120,392 subjects, 70,340 (58%) were younger than 65 years and 50,052 (42%) were aged 65 years or older. The cohort consisted of 102,530 whites (85%), 12,436 blacks (10%), and 5,426 men of other races. In addition, 96,504 patients (80%) had a Gleason score of 7 or less and 22,482 (19%) had a score of 8 or higher. Gleason score was unknown for 1,406 subjects (1%). The study population had a median follow-up of seven years.

The 15-year PCa-specific mortality was 3.7% among men with pathologic Gleason score of 7 or less and 12.7% among those with a Gleason score of 8 or higher.

“Our findings confirm that heart disease and other cancers remain the two leading causes of death among men being treated with radical prostatectomy, similar to the entire population of men without prostate cancer over age 40,” the authors wrote.

In an interview, Dr. Shikanov observed, “The study provides estimates that are relevant to the U.S. population and are free of the potential selection bias seen in single-institution series from referral centers.” Patients, he noted, should be made aware that CVD and other cancers are major causes of death after RP, and they should strive to maintain a healthy lifestyle.

In another recent study, Peter C. Albertsen, MD, of the University of Connecticut Health Center in Farmington, and colleagues analyzed a SEER-Medicare cohort of 19,639 men aged 66 years and older on active surveillance for localized PCa and found that the 10-year overall mortality ranged from 28.8% to 94.3%, whereas PCSM was 2% to 27.5%, depending on age.

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