Survival outcomes in prostate cancer patients treated at an Indian tertiary care centre

Prostate cancer is an emerging public health concern in India, with rising incidence and varying survival outcomes. This study aimed to evaluate 5-year overall survival and identify prognostic factors among prostate cancer patients treated at Tata Memorial Hospital (TMH), Mumbai.

This retrospective study included all patients newly diagnosed with prostate cancer between January and December 2017 who received cancer-directed treatment at TMH. Patients were followed through 2022. Clinico-epidemiological variables including age, PSA levels, Gleason grade, clinical extent (EAU risk group classification), intent, completion status and treatment modality were analysed. Kaplan-Meier survival curves and Cox proportional hazards models were used to assess survival outcomes.

A total of 421 patients were included, with a mean (SD) age of 66 ± (8.39) years and a median (IQR) PSA of 45.9 (17-154) ng/ml. All patients were symptomatic at presentation, predominantly with urinary complaints (90.5%), followed by bone pain (3.6%) or both (5.9%). At diagnosis, 15.2% had localized disease, 25.8% had locally advanced disease, and 58.4% had metastatic cancer. The overall 5-year survival rate was 61%. Prognostic factors significantly associated with survival included age, PSA, Gleason grade and disease extent. Patients with PSA > 1000 ng/ml had the poorest prognosis (33% 5-year survival). Survival varied by age group, declining from 66% in those aged 66-75 years to 45% in patients >75 years, although this trend was not statistically significant in adjusted analysis (p = 0.46). Disease extent demonstrated a strong survival gradient: 89% in localized disease, 79% in locally advanced and 41% in metastatic cancer, with metastatic disease showing a significantly increased adjusted mortality risk (HR: 4.59; p 0.004). Curative treatment intent was associated with markedly better outcomes, with a 5-year survival of 81% compared to 40% among those receiving palliative care. Similarly, treatment adherence had a substantial impact on prognosis, with patients completing therapy achieving a 65% 5-year survival rate, in contrast to only 12% among those with incomplete treatment (adjusted HR: 3.62; p < 0.001). Treatment modality also influenced survival: patients treated with ADT alone had the lowest 5-year survival (35%) and a significantly higher mortality risk (adjusted HR:1.65; p 0.01), whereas outcomes were more favourable with radical prostatectomy with adjuvant therapy (75%; adjusted HR: 1.21 p 0.80).

Survival in prostate cancer is strongly influenced by clinical extent at diagnosis, PSA, Gleason grade and treatment. Improving early detection, expanding multimodal treatment strategies and ensuring treatment completion are critical to enhancing outcomes in India.