Younger Men Who Survive 10 Years After Radical Prostatectomy Are More Likely to Die of Non–Cancer-Related Causes
A new study suggests that after radical prostatectomy for high-risk prostate cancer, both the age of the patient and the time survived since the operation have a significant impact on the cause of death. This means that, for young men with high-risk prostate cancer, doctors may have to reevaluate long-term clinical priorities with increasing time since surgery. This study was presented by Bianchi et al at the European Association of Urology (EAU) 2015 Congress in Madrid (Abstract 634).
Study Details
These findings are based on the efforts of a multi-institutional international collaboration developed to record long-term outcomes of patients classified as having “high-risk” prostate cancer who were treated with radical prostatectomy. The study team was able to compile a database of 7,650 patients from 14 different tertiary care centers in Italy, the United States, France, Belgium, Germany, Poland, Switzerland, and the Netherlands. Within this population, researchers were able to identify 612 patients treated with radical prostatectomy over a 26-year period (1987–2013) who were under the age of 60. The median follow-up time was 89 months. For each patient, the number of cancer-specific deaths were recorded and compared with the number of deaths from other causes.
They found that in patients younger than 60 years of age, there was a higher probability of dying of prostate cancer than of other causes in the first 10 years after a radical prostatectomy. Five years after surgery, the rate of cancer-specific mortality was 7.3%, and other-cause mortality was 2.6%. This disparity also held true at 8 years after surgery, though the gap diminished slightly, with cancer-specific mortality decreasing to 6.7% and other-cause mortality increasing to 5.8%.
However, after 10 years, cancer deaths decreased further, and other causes of death become more significant. Ten years after surgery, the cancer-specific mortality rate was 5.3%, whereas the other-cause mortality was 9.9%.
Shifting Focus of Care
The study findings suggest that with increasing time since radical prostatectomy, care for these patients should gradually shift from prioritizing prostate cancer toward prioritizing other health risks (such as heart disease), even though regular urologic checkups should continue.
Lead author Marco Bianchi, PhD, Head of the Unit of Chromatin Dynamics at San Raffaele Hospital in Milano, Italy, said, “These results confirm that if you are under 60 when you undergo a radical prostatectomy, you need close follow-up, concentrating on possible cancer recurrence for the first 10 years. After that time, patients should worry less about prostate cancer and priorities may need to shift to other health risks, even though regular urologic checkups should be continued.”
He continued, “What this means in practice is that each patient needs close, personalized, regular monitoring, where the urologist should not focus only on prostate cancer features, but also on the general health status of the patients. This is particularly important especially with increasing time after surgery, since new comorbidities, such as heart disease, may develop and become a more immediate risk to the patient’s health.”
Dr. Bianchi is the corresponding author of the research.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
