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Predicting 15-year prostate cancer specific mortality after radical prostatectomy
Scott E Eggener1, Peter T Scardino, Patrick C Walsh
1Section of Urology, University of Chicago Medical Center, Chicago, Illinois, USA.
The Journal of Urology
|January 18, 2011
Summary
Radical prostatectomy outcomes for prostate cancer are better understood with new data. Poorly differentiated cancer and seminal vesicle invasion significantly predict mortality, allowing for more accurate risk assessment.
Area of Science:
- Urology
- Oncology
- Pathology
Background:
- Long-term prostate cancer specific mortality after radical prostatectomy is not well-defined, especially with increased screening.
- Understanding the natural history and pathological risk factors for mortality is crucial for treatment decisions.
Purpose of the Study:
- To define long-term prostate cancer specific mortality after radical prostatectomy.
- To identify pathological risk factors for prostate cancer specific mortality in screen-detected prostate cancers.
Main Methods:
- A competing risk regression model was developed using clinical and pathological data from 11,521 patients treated between 1987 and 2005.
- The model was validated on an independent cohort of 12,389 patients.
Main Results:
- The 15-year prostate cancer specific mortality rate was 7%.
- Primary/secondary Gleason grade 4-5, seminal vesicle invasion, and surgery year were significant predictors.
- A nomogram demonstrated high accuracy (concordance index 0.92) in predicting mortality based on pathological parameters.
Conclusions:
- Poorly differentiated cancer and seminal vesicle invasion are key determinants of prostate cancer specific mortality post-radical prostatectomy.
- Prostate cancer specific mortality risk can be accurately predicted using known pathological features.
