Long-Term Oncologic Outcomes: A 40 Year Radical Prostatectomy Single Institution Series

UroToday.com - Single institution long-term outcomes for radical prostatectomy are scarce in the literature. In the August 2006 issue of the Journal of Urology, Dr. Porter from the Virginia Mason Medical Center, Seattle, WA reports on 25-year cancer outcomes for radical prostatectomy (RP).

The study cohort was comprised of 752 evaluable patients who underwent RP without neoadjuvant androgen deprivation therapy between 1954 and 1994. Thirteen surgeons performed the operations. Clinical and pathologic data were reviewed. PSA testing was included since 1988.

Mean patient age was 63.6 years. In 341 men (45%), the prostate cancer (CaP) was non-organ confined and positive surgical margins occurred in 37.6%. Gleason score 7 or higher tumors were reported in 31% and additional radiotherapy and androgen deprivation therapy was administered in 15.7% and 15.2%, respectively. Median follow-up was 11.4 years. In the PSA era, a PSA recurrence was noted in 189/601 evaluable patients (31.4%). Recurrences were local in 8.4% and metastatic in 11.3%.

Survival was estimated by 5 definitions with outcomes as follows; prostate cancer specific survival 99% at 5 years to 82% at 25 years, overall survival 94% at 5 years to 19% at 25 years, PSA progression-free survival 85%at 5 years to 55% at 25 years, distant recurrence-free survival 96% at 5 years and 78% at 25 years and local progression-free survival 95% at 5 years and 88% at 25 years. In multivariate regression analysis, only Gleason sum and delivery of androgen deprivation therapy remained statistically significant.

This long-term follow-up study supports that local and distant CaP control and cancer specific mortality are excellent at 25 years, but freedom from biochemical recurrence is less impressive. In the long-term, deaths are primarily the result of causes other than cancer.

By Christopher P. Evans, M.D.

J Urol 2006;176:569-74.
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