Survival after radical prostatectomy
A. Krongrad, H. Lai and S. Lai
Department of Urology, University of Miami School of Medicine, and the Veterans Affairs Medical Center, FL 33125, USA. akrongra@mednet.med.miami.edu
CONTEXT: The generalizability of currently available estimates of survival
after radical prostatectomy is theoretically limited. OBJECTIVE: To obtain
generalizable estimates of survival after radical prostatectomy. DESIGN: A
population-based retrospective cohort study. SETTING: Nine regions of the
United States. PATIENTS: Patients who were diagnosed with prostate cancer
between 1983 and 1987 and underwent radical prostatectomy and lymph node
dissection. MAIN OUTCOME MEASURES: Proportional hazards models
incorporating geographical region, age, race, pathological stage, lymph
node involvement, and tumor grade to identify independent correlates of
disease-specific and overall survival and life table analyses to estimate
10-year survival distributions. RESULTS: A total of 3626 patients with a
mean age of 65 years were included in the study; 92.6% were white, 54.2%
had moderate-grade cancer, 60.4% had no extension beyond the prostate, and
91.2% had no lymph node involvement. Using San Francisco-Oakland, Calif, as
a reference region, no other region was significantly associated with a
risk of disease-specific or overall mortality. Older age and black race
were independently associated with worse overall but not disease-specific
survival. Higher grade, extension beyond the prostate, and lymph node
involvement were independently associated with worse disease-specific and
overall survival. Estimates of 10-year disease-specific survival ranged
from 75% to 97% for patients with well-differentiated and moderately
differentiated cancers and from 60% to 86% for patients with poorly
differentiated cancers. CONCLUSIONS: Neither disease-specific nor overall
survival varied by region, suggesting geographically uniform assessments of
risk in patient selection for radical prostatectomy. Across regions,
overall survival varied by patient and prostate cancer characteristics
while disease-specific survival varied substantially by prostate cancer but
not patient characteristics. The present analyses provide the most
generalizable current estimates of survival after radical prostatectomy.
