High-risk prostate cancer (PCa) patients younger than 60 years are more likely to die from their malignancy than from other causes during the first 10 years after radical prostatectomy (RP). Once past that point, however, other causes of death become more likely, according to research presented at the European Association of Urology conference in Madrid, Spain. The findings have important clinical implications.
“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,” stated lead researcher Marco Bianchi, MD, of Ospedale San Raffaele in Milano, Italy, in a news release. “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.”
For the international, multicenter study, the investigators identified 612 patients aged 39-60 treated with radical prostatectomy for high-risk PCa (defined as PSA above 20 ng/mL, clinical stage 3 or higher, or biopsy Gleason score 8-10) from 1987 to 2013. Patients were from the United States, Italy, France, Belgium, Germany, Poland, Switzerland, or the Netherlands.
During the study period, 57 (9.3%) patients died of cancer and 37 (6%) of other causes. At 5, 10, and 15 years, cancer-specific survival rates were 93.9%, 87%, and 82.2%, respectively. Overall survival rates at the same time points were 91%, 82.1%, and 69.6%.
After analyses, significant factors predicting PCa-related death emerged, including year of surgery, Gleason score, clinical stage, surgical margins status, and lymph-node invasion.
Among patients who survived 5 and 8 years after surgery, the probability of dying from PCa within the next 5 years was higher than dying of other causes (7.3 and 6.7% vs. 2.6 and 5.8%, respectively). By contrast, once patients survived 10 years after RP, other-cause mortality became the main cause of death during the next 5 years (9.9% vs. 5.3% for cancer-specific mortality).
The researchers suggest strict follow-up of patients in the first 10 years after RP. Thereafter, with periodic urology check-ups, a comorbidity profile reassessment should be made to stratify patient prognosis.
“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,” Dr. Bianchi said.
- European Association of Urology news release, March 22, 2015.