Very long-term survival patterns of young patients treated with radical prostatectomy for high-risk prostate cancer

Paolo Dell'Oglio, Robert Jeffrey Karnes, Steven Joniau, Martin Spahn, Paolo Gontero, Lorenzo Tosco, Nicola Fossati, Burkhard Kneitz, Piotr Chlosta, Markus Graefen, Giansilvio Marchioro, Marco Bianchi, Rafael Sanchez-Salas, Pierre I. Karakiewicz, Hendrik Van Poppel, Francesco Montorsi, Alberto Briganti

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Objective: In patients with a long life expectancy with high-risk (HR) prostate cancer (PCa), the chance to die from PCa is not negligible and may change significantly according to the time elapsed from surgery. The aim of this study was to evaluate long-term survival patterns in young patients treated with radical prostatectomy (RP) for HRPCa. Materials and methods: Within a multiinstitutional cohort, 600 young patients (≤59 years) treated with RP between 1987 and 2012 for HRPCa (defined as at least one of the following adverse characteristics: prostate specific antigen>20, cT3 or higher, biopsy Gleason sum 8-10) were identified. Smoothed cumulative incidence plot was performed to assess cancer-specific mortality (CSM) and other cause mortality (OCM) rates at 10, 15, and 20 years after RP. The same analyses were performed to assess the 5-year probability of CSM and OCM in patients who survived 5, 10, and 15 years after RP. A multivariable competing risk regression model was fitted to identify predictors of CSM and OCM. Results: The 10-, 15- and 20-year CSM and OCM rates were 11.6% and 5.5% vs. 15.5% and 13.5% vs. 18.4% and 19.3%, respectively. The 5-year probability of CSM and OCM rates among patients who survived at 5, 10, and 15 years after RP, were 6.4% and 2.7% vs. 4.6% and 9.6% vs. 4.2% and 8.2%, respectively. Year of surgery, pathological stage and Gleason score, surgical margin status and lymph node invasion were the major determinants of CSM (all P≤0.03). Conversely, none of the covariates was significantly associated with OCM (all P≥ 0.09). Conclusions: Very long-term cancer control in young high-risk patients after RP is highly satisfactory. The probability of dying from PCa in young patients is the leading cause of death during the first 10 years of survivorship after RP. Thereafter, mortality not related to PCa became the main cause of death. Consequently, surgery should be consider among young patients with high-risk disease and strict PCa follow-up should enforce during the first 10 years of survivorship after RP.

Original languageEnglish (US)
JournalUrologic Oncology: Seminars and Original Investigations
DOIs
StateAccepted/In press - Sep 13 2015

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Prostatectomy
Prostatic Neoplasms
Survival
Mortality
Neoplasms
Cause of Death
Survival Rate
Neoplasm Grading
Prostate-Specific Antigen
Life Expectancy
Lymph Nodes

Keywords

  • Competing risk
  • High-risk
  • Prostate cancer
  • Radical prostatectomy
  • Survival
  • Young patients

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

Very long-term survival patterns of young patients treated with radical prostatectomy for high-risk prostate cancer. / Dell'Oglio, Paolo; Karnes, Robert Jeffrey; Joniau, Steven; Spahn, Martin; Gontero, Paolo; Tosco, Lorenzo; Fossati, Nicola; Kneitz, Burkhard; Chlosta, Piotr; Graefen, Markus; Marchioro, Giansilvio; Bianchi, Marco; Sanchez-Salas, Rafael; Karakiewicz, Pierre I.; Poppel, Hendrik Van; Montorsi, Francesco; Briganti, Alberto.

In: Urologic Oncology: Seminars and Original Investigations, 13.09.2015.

Research output: Contribution to journalArticle

Dell'Oglio, P, Karnes, RJ, Joniau, S, Spahn, M, Gontero, P, Tosco, L, Fossati, N, Kneitz, B, Chlosta, P, Graefen, M, Marchioro, G, Bianchi, M, Sanchez-Salas, R, Karakiewicz, PI, Poppel, HV, Montorsi, F & Briganti, A 2015, 'Very long-term survival patterns of young patients treated with radical prostatectomy for high-risk prostate cancer', Urologic Oncology: Seminars and Original Investigations. https://doi.org/10.1016/j.urolonc.2015.11.018
Dell'Oglio, Paolo ; Karnes, Robert Jeffrey ; Joniau, Steven ; Spahn, Martin ; Gontero, Paolo ; Tosco, Lorenzo ; Fossati, Nicola ; Kneitz, Burkhard ; Chlosta, Piotr ; Graefen, Markus ; Marchioro, Giansilvio ; Bianchi, Marco ; Sanchez-Salas, Rafael ; Karakiewicz, Pierre I. ; Poppel, Hendrik Van ; Montorsi, Francesco ; Briganti, Alberto. / Very long-term survival patterns of young patients treated with radical prostatectomy for high-risk prostate cancer. In: Urologic Oncology: Seminars and Original Investigations. 2015.
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abstract = "Objective: In patients with a long life expectancy with high-risk (HR) prostate cancer (PCa), the chance to die from PCa is not negligible and may change significantly according to the time elapsed from surgery. The aim of this study was to evaluate long-term survival patterns in young patients treated with radical prostatectomy (RP) for HRPCa. Materials and methods: Within a multiinstitutional cohort, 600 young patients (≤59 years) treated with RP between 1987 and 2012 for HRPCa (defined as at least one of the following adverse characteristics: prostate specific antigen>20, cT3 or higher, biopsy Gleason sum 8-10) were identified. Smoothed cumulative incidence plot was performed to assess cancer-specific mortality (CSM) and other cause mortality (OCM) rates at 10, 15, and 20 years after RP. The same analyses were performed to assess the 5-year probability of CSM and OCM in patients who survived 5, 10, and 15 years after RP. A multivariable competing risk regression model was fitted to identify predictors of CSM and OCM. Results: The 10-, 15- and 20-year CSM and OCM rates were 11.6{\%} and 5.5{\%} vs. 15.5{\%} and 13.5{\%} vs. 18.4{\%} and 19.3{\%}, respectively. The 5-year probability of CSM and OCM rates among patients who survived at 5, 10, and 15 years after RP, were 6.4{\%} and 2.7{\%} vs. 4.6{\%} and 9.6{\%} vs. 4.2{\%} and 8.2{\%}, respectively. Year of surgery, pathological stage and Gleason score, surgical margin status and lymph node invasion were the major determinants of CSM (all P≤0.03). Conversely, none of the covariates was significantly associated with OCM (all P≥ 0.09). Conclusions: Very long-term cancer control in young high-risk patients after RP is highly satisfactory. The probability of dying from PCa in young patients is the leading cause of death during the first 10 years of survivorship after RP. Thereafter, mortality not related to PCa became the main cause of death. Consequently, surgery should be consider among young patients with high-risk disease and strict PCa follow-up should enforce during the first 10 years of survivorship after RP.",
keywords = "Competing risk, High-risk, Prostate cancer, Radical prostatectomy, Survival, Young patients",
author = "Paolo Dell'Oglio and Karnes, {Robert Jeffrey} and Steven Joniau and Martin Spahn and Paolo Gontero and Lorenzo Tosco and Nicola Fossati and Burkhard Kneitz and Piotr Chlosta and Markus Graefen and Giansilvio Marchioro and Marco Bianchi and Rafael Sanchez-Salas and Karakiewicz, {Pierre I.} and Poppel, {Hendrik Van} and Francesco Montorsi and Alberto Briganti",
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T1 - Very long-term survival patterns of young patients treated with radical prostatectomy for high-risk prostate cancer

AU - Dell'Oglio, Paolo

AU - Karnes, Robert Jeffrey

AU - Joniau, Steven

AU - Spahn, Martin

AU - Gontero, Paolo

AU - Tosco, Lorenzo

AU - Fossati, Nicola

AU - Kneitz, Burkhard

AU - Chlosta, Piotr

AU - Graefen, Markus

AU - Marchioro, Giansilvio

AU - Bianchi, Marco

AU - Sanchez-Salas, Rafael

AU - Karakiewicz, Pierre I.

AU - Poppel, Hendrik Van

AU - Montorsi, Francesco

AU - Briganti, Alberto

PY - 2015/9/13

Y1 - 2015/9/13

N2 - Objective: In patients with a long life expectancy with high-risk (HR) prostate cancer (PCa), the chance to die from PCa is not negligible and may change significantly according to the time elapsed from surgery. The aim of this study was to evaluate long-term survival patterns in young patients treated with radical prostatectomy (RP) for HRPCa. Materials and methods: Within a multiinstitutional cohort, 600 young patients (≤59 years) treated with RP between 1987 and 2012 for HRPCa (defined as at least one of the following adverse characteristics: prostate specific antigen>20, cT3 or higher, biopsy Gleason sum 8-10) were identified. Smoothed cumulative incidence plot was performed to assess cancer-specific mortality (CSM) and other cause mortality (OCM) rates at 10, 15, and 20 years after RP. The same analyses were performed to assess the 5-year probability of CSM and OCM in patients who survived 5, 10, and 15 years after RP. A multivariable competing risk regression model was fitted to identify predictors of CSM and OCM. Results: The 10-, 15- and 20-year CSM and OCM rates were 11.6% and 5.5% vs. 15.5% and 13.5% vs. 18.4% and 19.3%, respectively. The 5-year probability of CSM and OCM rates among patients who survived at 5, 10, and 15 years after RP, were 6.4% and 2.7% vs. 4.6% and 9.6% vs. 4.2% and 8.2%, respectively. Year of surgery, pathological stage and Gleason score, surgical margin status and lymph node invasion were the major determinants of CSM (all P≤0.03). Conversely, none of the covariates was significantly associated with OCM (all P≥ 0.09). Conclusions: Very long-term cancer control in young high-risk patients after RP is highly satisfactory. The probability of dying from PCa in young patients is the leading cause of death during the first 10 years of survivorship after RP. Thereafter, mortality not related to PCa became the main cause of death. Consequently, surgery should be consider among young patients with high-risk disease and strict PCa follow-up should enforce during the first 10 years of survivorship after RP.

AB - Objective: In patients with a long life expectancy with high-risk (HR) prostate cancer (PCa), the chance to die from PCa is not negligible and may change significantly according to the time elapsed from surgery. The aim of this study was to evaluate long-term survival patterns in young patients treated with radical prostatectomy (RP) for HRPCa. Materials and methods: Within a multiinstitutional cohort, 600 young patients (≤59 years) treated with RP between 1987 and 2012 for HRPCa (defined as at least one of the following adverse characteristics: prostate specific antigen>20, cT3 or higher, biopsy Gleason sum 8-10) were identified. Smoothed cumulative incidence plot was performed to assess cancer-specific mortality (CSM) and other cause mortality (OCM) rates at 10, 15, and 20 years after RP. The same analyses were performed to assess the 5-year probability of CSM and OCM in patients who survived 5, 10, and 15 years after RP. A multivariable competing risk regression model was fitted to identify predictors of CSM and OCM. Results: The 10-, 15- and 20-year CSM and OCM rates were 11.6% and 5.5% vs. 15.5% and 13.5% vs. 18.4% and 19.3%, respectively. The 5-year probability of CSM and OCM rates among patients who survived at 5, 10, and 15 years after RP, were 6.4% and 2.7% vs. 4.6% and 9.6% vs. 4.2% and 8.2%, respectively. Year of surgery, pathological stage and Gleason score, surgical margin status and lymph node invasion were the major determinants of CSM (all P≤0.03). Conversely, none of the covariates was significantly associated with OCM (all P≥ 0.09). Conclusions: Very long-term cancer control in young high-risk patients after RP is highly satisfactory. The probability of dying from PCa in young patients is the leading cause of death during the first 10 years of survivorship after RP. Thereafter, mortality not related to PCa became the main cause of death. Consequently, surgery should be consider among young patients with high-risk disease and strict PCa follow-up should enforce during the first 10 years of survivorship after RP.

KW - Competing risk

KW - High-risk

KW - Prostate cancer

KW - Radical prostatectomy

KW - Survival

KW - Young patients

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