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Keywords:

  • radical prostatectomy;
  • localised prostate cancer;
  • survival;
  • cause of death

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.