Survival after radical prostatectomy for clinically localised prostate cancer: a population-based study

Authors

  • Martin Andreas Røder,

    Corresponding author
    1. Copenhagen Prostate Cancer Center and Department of Urology, Rigshospitalet Copenhagen University Hospital, Faculty of Health and Medical Sciences, Copenhagen
    • Correspondence: M. Andreas Røder, Urology Research Unit, Tagensvej 20, afsnit 7521, Copenhagen N DK-2200, Denmark.

      e-mail: andreasroder@gmail.com

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  • Klaus Brasso,

    1. Copenhagen Prostate Cancer Center and Department of Urology, Rigshospitalet Copenhagen University Hospital, Faculty of Health and Medical Sciences, Copenhagen
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  • Ib Jarle Christensen,

    1. The Finsen Laboratory, Copenhagen Biotech Research and Innovation Centre (BRIC), Rigshospitalet Copenhagen University Hospital, Faculty of Health and Medical Sciences, Copenhagen
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  • Jørgen Johansen,

    1. Department of Urology, Regional Hospital West Jutland, Holstebro
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  • Niels Christian Langkilde,

    1. Department of Urology, Aalborg University Hospital, Faculty of Medicine, Aalborg
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  • Helle Hvarness,

    1. Copenhagen Prostate Cancer Center and Department of Urology, Rigshospitalet Copenhagen University Hospital, Faculty of Health and Medical Sciences, Copenhagen
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  • Steen Carlsson,

    1. Department of Urology, Odense University Hospital, Faculty of Health Sciences, Odense
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  • Henrik Jakobsen,

    1. Department of Urology, Herlev Hospital, Copenhagen University Hospital, Faculty of Health and Medical Sciences, Herlev
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  • Michael Borre,

    1. Department of Urology, Skejby, Aarhus University Hospital, Department of Clinical Medicine, Aarhus, Denmark
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  • Peter Iversen

    1. Copenhagen Prostate Cancer Center and Department of Urology, Rigshospitalet Copenhagen University Hospital, Faculty of Health and Medical Sciences, Copenhagen
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Abstract

Objectives

  • To describe survival and cause of death in a nationwide cohort of Danish patients with prostate cancer undergoing radical prostatectomy (RP).
  • To describe risk factors associated with prostate cancer mortality.

Patients and Methods

  • Observational study of 6489 men with localised prostate cancer treated with RP at six different hospitals in Denmark between 1995 and 2011.
  • Survival was described using Kaplan–Meier estimates. Causes of death were obtained from the national registry and cross-checked with patient files.
  • Cumulative incidence of death, any cause and prostate cancer-specific, was described using Nelson–Aalen estimates.
  • Risk for prostate cancer death was analysed in a Cox multivariate regression model using the covariates: age, cT-category, PSA level and biopsy Gleason score.

Results

  • The median follow-up was 4 years. During follow-up, 328 patients died, 109 (33.2%) from prostate cancer and 219 (66.8%) from other causes. Six patients (0.09%) died ≤30 days of RP.
  • In multivariate analysis, cT-category was a predictor of prostate cancer death (P < 0.001). Compared with T1 disease, both cT2c (hazard ratio [HR] 2.2) and cT3 (HR 7.2) significantly increased the risk of prostate cancer death. For every doubling of PSA level the risk of prostate cancer death was increased by 34.8% (P < 0.001). Biopsy Gleason score 4 + 3 and ≥8 were associated with an increased risk of prostate cancer death compared with biopsy Gleason score ≤ 6 of 2.3 and 2.7 (P = 0.003), respectively.
  • The cumulative hazard of all-cause and prostate cancer-specific mortality after 10 years was 15.4% (95% confide3nce interval [CI] 13.2–17.7) and 6.6% (95% CI 4.9–8.2) respectively.

Conclusions

  • We present the first survival analysis of a complete, nationwide cohort of men undergoing RP for localised prostate cancer.
  • The main limitation of the study was the relatively short follow-up.
  • Interestingly, our national results are comparable to high-volume, single institution, single surgeon series.

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