Long-term data on the survival of patients with prostate cancer treated with radical prostatectomy in the prostate-specific antigen era.

STUDY TYPE

Therapy (case series) Level of Evidence 4.

OBJECTIVE

To examine the long-term rates of biochemical recurrence (BCR)-free survival, cancer-specific mortality (CSM)-free survival, and overall survival (OS) in patients with prostate cancer treated with open radical prostatectomy (RP) in the prostate-specific antigen (PSA) era.

PATIENTS AND METHODS

The study comprised 436 patients who were treated with RP between 1992 and 1997 at our institution. None received adjuvant/salvage therapy in the absence of BCR. The BCR-free, CSM-free and OS rates were defined using the Kaplan-Meier method. Multivariable Cox-regression models were used to test the effect of age, preoperative PSA level, neoadjuvant hormonal therapy, pT stage, lymph node status, RP Gleason sum and surgical margin status on BCR.

RESULTS

The median follow-up of censored patients was 122, 128, and 132 months for, respectively, BCR-free, CSM-free and OS estimates. The 10-year event-free survival rates for the same endpoints were 60%, 94% and 86%, respectively. Preoperative PSA level, RP Gleason sum, pT stage, lymph node status, and surgical margin status were independent predictors of BCR (all adjusted P < 0.05).

CONCLUSIONS

This study is the first to evaluate the long-term cancer control outcomes after RP from a European country in the PSA era. Our data indicate that RP provides excellent long-term survival rates in patients with clinically localized prostate cancer. Although approximately 40% of patients have BCR after 10 years of follow-up, the CSM rate after 10 years is as low as 6%.