Radical prostatectomy is associated with excellent long-term disease control for localized prostate cancer. Prior studies have suggested an increased risk of short-term complications among older men who underwent radical prostatectomy, but these studies did not adjust for comorbidity.
We examined mortality and complications occurring within 30 days following radical prostatectomy among all 11,010 men who underwent this surgery in Ontario, Canada, between 1990 and 1999 using multivariable logistic regression modeling. We adjusted for comorbidity using two common comorbidity indices. Statistical tests were two-sided.
Overall, 53 men (0.5%) died, and 2195 [corrected] (19.9%[corrected]) had one or more complications within 30 days of radical prostatectomy. In models adjusted for comorbidity and year of surgery, age was associated with an increased risk of 30-day mortality (odds ratio = 2.04 per decade of age, 95% confidence interval [CI] = 1.23 to 3.39). However, the absolute 30-day mortality risk was low, even in older men, at 0.66% (95% CI = 0.2 to 1.1%) for men aged 70-79 years. In adjusted models, age was associated with an increased risk of cardiac (Ptrend
Comment In: J Natl Cancer Inst. 2006 Mar 15;98(6):421; author reply 421-216537836
Erratum In: J Natl Cancer Inst. 2007 Nov 7;99(21):1648
The wait times for prostate cancer surgery in Canada has increased over the past 2 decades. Prolonged wait times have a negative impact on patient quality of life but the effect on long-term cancer control is undefined. We conducted a systematic literature review to examine the best available evidence addressing the following key questions: . What is the reported time interval for prostate cancer patients from the decision to operate until the day of cancer surgery? . Are there recommendations/guidelines in the urological cancer literature and, if so, how do the Canadian times compare? . Is there a known association between duration of wait time beyond the recommended standard and clinical outcome (i.e. recurrence free survival, overall survival)?
A structured literature search of Medline, Pubmed, CINAHL, EMBASE, the Cochrane Database of Systematic Reviews, the Cochrane Database of Abstracts of Reviews of Effects, Healthstar and Google Scholar was performed from January 1980 to January 2006 for published epidemiological studies and international guidelines/consensus documents that evaluated surgical wait times for prostate cancer. Data extracted from eligible studies included median time to prostate cancer surgery from the point of patient contact and adjusted hazard ratios (HR) for wait times. All HR from the included studies were examined for the possibility of statistical pooling via meta analytic techniques.
Thirteen studies evaluating wait times for prostate cancers were identified, six of which measured the HR for prostate specific antigen (PSA) recurrence in patients with prolonged wait times. Differences in study data availability, method of analysis and wait time definitions precluded statistical pooling of the findings. Median wait times from various points of patient contact ranged from 42 days to 244 days. In the six Canadian studies identified, wait times ranged from 42 days (consultation to operation) to 83 days (consultation to hospital admission). This was in contrast to national and international guidelines, which recommended a maximum wait time for prostatectomy between 2 to 4 weeks. The association between surgical delay and disease recurrence remained controversial where only two of six epidemiological studies reported at least a statistical trend for an increased risk of PSA recurrence free survival in patients with surgical delays of 3 months or more.
Unlike comparable countries, surgical wait times in Canada appear to be increasing and are well beyond the threshold recommended by national and international expert bodies. Even though the association between surgical delay and disease recurrence remains unclear, there is an ongoing concern that the psychological impact of prolonged waiting could negatively impact patient outcomes. To address these important issues, the surgical wait times (SWAT) initiative is mandated to provide the necessary guidance and recommendations to the federal and provincial governments. Through a partnership of the key stakeholders, it is the vision of SWAT to ultimately improve the care and quality of life of prostate cancer patients and their families.
To examine the effect of surgical volume (SV) on 30-day mortality after radical prostatectomy (RP; reportedly 0.1-0.6% and influenced by age and comorbidities) and to explore the most informative SV, age and comorbidity thresholds to distinguish between high- and low-risk men.
Between 1989 and 2000, 9208 consecutive patients were treated with RP. The effects on 30-day mortality of (either continuously coded or categorized) patient age, comorbidities (Charlson Comorbidity Index, CCI) and SV were tested in multivariable logistic regression models. The models were corrected for overfit bias using 200 bootstrap re-samples and were displayed graphically as nomograms.
The overall 30-day mortality was 0.52%; being younger (27 RPs, 0.07 vs 0.6% otherwise, P = 0.049) had a protective effect and represented independent predictors of 30-day mortality. After correction for overfit bias, their combined input was 72.3% accurate in predicting 30-day mortality, vs 67.1% (P 27 RPs) can accurately identify patients at negligible risk of 30-day mortality.
The number of patients in Sweden treated with radical prostatectomy for localized prostate cancer has increased exponentially. The extent to which this increase reflects treatment of nonlethal disease detected through prostate-specific antigen (PSA) screening is unknown.
We undertook a nationwide study of all 18,837 patients with prostate cancer treated with radical prostatectomy in Sweden from 1988 to 2008 with complete follow-up through 2009. We compared cumulative incidence curves, fit Cox regression and cure models, and conducted a simulation study to determine changes in treatment of nonlethal cancer, in cancer-specific survival over time, and effect of lead-time due to PSA screening.
The annual number of radical prostatectomies increased 25-fold during the study period. The 5-year cancer-specific mortality rate decreased from 3.9% [95% confidence interval (CI), 2.5-5.3] among patients diagnosed between 1988 and 1992 to 0.7% (95% CI, 0.4-1.1) among those diagnosed between 1998 and 2002 (P(trend)
Cites: N Engl J Med. 2002 Sep 12;347(11):790-612226149
The aim of this study was to analyse relative survival, excess mortality and gain in life expectancy in men who underwent radical prostatectomy (RP) for localized prostate cancer (PCa) between 1995 and 2011 in Denmark.
The study population comprised the complete cohort of 6489 men who underwent RP between 1995 and 2011. Risk of mortality was calculated using a competing risk model. Relative survival, excess mortality rate (EMR) and gain in life expectancy in men undergoing RP were calculated using a matched cohort Danish population based on date of birth and date of surgery.
During follow-up 328 patients died, 109 (33.2%) of PCa and 219 (66.8%) of other causes. The cumulative incidence of PCa mortality was 5.8% [95% confidence interval (CI) 4.4, 7.2] after 10 years. Relative survival was significantly above 1.0 for RP patients, except for high-risk patients. EMR was -9.34 (95% CI -10.56, -8.13) after 10 years, i.e. nine men would die in excess of the general population. Overall, the gain in life expectancy in men undergoing RP compared with the general population was 0.41 years.
This population-based study demonstrated that the gain in life expectancy with RP compared with the general population in Denmark is minimal.
On call. September 11 was an emotional day for all of us, but September 12 was a confusing day for me. I read two newspapers that reported on research in the New England Journal of Medicine. The New York Times headline said: "Prostate cancer surgery found to cut death risk," but the Washington Post announced: "Studies find no advantage to prostate cancer surgery." Which was right?
BACKGROUND: The organisation, volume and early morbidity after radical prostatectomy has not been researched in Denmark. MATERIALS AND METHODS: The National Hospital Register was searched for all radical prostatectomies in Denmark from 2004-2007, including mortality and readmissions. RESULTS: In total, 1469 radical prostatectomies were performed, initially in 9 departments, decreasing to 6 departments in 2007. From 2004 to 2007 the number of operations increased by approximately 60%. Median hospital stay was 4 days (mean 5.1 days) without any differences between departments. Mortality was 0.2%. CONCLUSION: There is an increasing rate of radical prostatectomies in Denmark. It is proposed that a national database be established to monitor early and long-term outcomes, including the role of surgical technique (nerve sparing, laparoscopic/robotic surgery, etc.) in order to ensure optimal organisation.
The objective of this study was to investigate standardised relative survival and mortality ratio for patients undergoing radical prostatectomy for localized prostate cancer at our institution.
Between 1995 and 2010, a total of 1,350 consecutive patients underwent radical prostatectomy. Patients were followed prospectively per protocol. No patients were lost to follow-up. Overall and cause-specific survival were described using Kaplan-Meier plots. Standardized relative survival and mortality ratio were calculated based on expected survival in the age-matched Danish population using the methods and macros described by Dickmann. The country-specific population mortality rates used for calculation of the expected survival were based on data from The Human Mortality Database.
The median follow-up was 3.4 years (range: 0-14.3 years). A total of 59 (4.4%) patients died during follow-up. In all, 17 (1.3%) patients died of prostate cancer. The estimated ten-year overall survival was 89.3%. The cancer-specific survival was estimated to 96.6% after ten years. Relative survival was 1.04 after five years and 1.14 after ten years. The standardized mortality ratio, i.e. observed mortality/expected mortality, was 0.61 and 0.39 at five and ten years, respectively.
The overall and cancer-specific ten-year survival in a consecutive series of patients in a non-screened Danish population is = 89%. The survival and mortality ratio is significantly better than expected in the age-matched background population. This finding is likely explained by selection bias. Although the results indicate an excellent outcome in terms of cancer control, the efficacy of prostatectomy for localized prostate cancer remains at debate.
To assess 90-day postoperative mortality after robot-assisted laparoscopic radical prostatectomy (RARP) and retropubic radical prostatectomy (RRP) using nationwide population-based registry data.
We conducted a cohort study using the National Prostate Cancer Register of Sweden, including 22 344 men with localized prostate cancer of clinical stage T1-T3, whose prostate-specific antigen levels were