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30-day mortality and major complications after radical prostatectomy: influence of age and comorbidity.

https://arctichealth.org/en/permalink/ahliterature172378
Source
J Natl Cancer Inst. 2005 Oct 19;97(20):1525-32
Publication Type
Article
Date
Oct-19-2005
Author
Shabbir M H Alibhai
Marc Leach
George Tomlinson
Murray D Krahn
Neil Fleshner
Eric Holowaty
Gary Naglie
Author Affiliation
Division of General Internal Medicine and Clinical Epidemiology, University Health Network, Toronto, Canada. shabbir.alibhai@uhn.on.ca
Source
J Natl Cancer Inst. 2005 Oct 19;97(20):1525-32
Date
Oct-19-2005
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Cohort Studies
Comorbidity
Humans
Logistic Models
Male
Middle Aged
Multivariate Analysis
Ontario - epidemiology
Prostatectomy - adverse effects - methods - mortality
Prostatic Neoplasms - mortality - surgery
Registries
Retrospective Studies
Risk assessment
Risk factors
Abstract
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
Notes
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
PubMed ID
16234566 View in PubMed
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Does prolonging the time to prostate cancer surgery impact long-term cancer control: a systematic review of the literature.

https://arctichealth.org/en/permalink/ahliterature168493
Source
Can J Urol. 2006 Jun;13 Suppl 3:16-24
Publication Type
Article
Date
Jun-2006
Author
Fred Saad
Antonio Finelli
George Dranitsaris
Larry Goldenberg
Scott Bagnell
Martin Gleave
Neil Fleshner
Author Affiliation
University of Montreal, CHUM, Hôpital Notre-Dame, Montreal, Quebec, Canada.
Source
Can J Urol. 2006 Jun;13 Suppl 3:16-24
Date
Jun-2006
Language
English
Publication Type
Article
Keywords
Appointments and Schedules
Canada
Disease-Free Survival
Humans
Male
Prostatic Neoplasms - mortality - surgery
Quality of Life
Recurrence
Time Factors
Abstract
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.
PubMed ID
16818008 View in PubMed
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The effect of surgical volume, age and comorbidities on 30-day mortality after radical prostatectomy: a population-based analysis of 9208 consecutive cases.

https://arctichealth.org/en/permalink/ahliterature158456
Source
BJU Int. 2008 Apr;101(7):826-32
Publication Type
Article
Date
Apr-2008
Author
Jochen Walz
Francesco Montorsi
Claudio Jeldres
Nazareno Suardi
Shahrokh F Shariat
Paul Perrotte
Philippe Arjane
Markus Graefen
Daniel Pharand
Pierre I Karakiewicz
Author Affiliation
Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Quebec, Canada.
Source
BJU Int. 2008 Apr;101(7):826-32
Date
Apr-2008
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Comorbidity
Epidemiologic Methods
General Surgery - statistics & numerical data
Humans
Male
Middle Aged
Prostatectomy - methods - mortality
Prostatic Neoplasms - mortality - surgery
Quebec - epidemiology
Abstract
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.
PubMed ID
18321316 View in PubMed
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Increasing use of radical prostatectomy for nonlethal prostate cancer in Sweden.

https://arctichealth.org/en/permalink/ahliterature121231
Source
Clin Cancer Res. 2012 Dec 15;18(24):6742-7
Publication Type
Article
Date
Dec-15-2012
Author
Ruth Etzioni
Lorelei Mucci
Shu Chen
Jan-Erik Johansson
Katja Fall
Hans-Olov Adami
Author Affiliation
Program in Biostatistics, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109-1024, USA. retzioni@fhcrc.org
Source
Clin Cancer Res. 2012 Dec 15;18(24):6742-7
Date
Dec-15-2012
Language
English
Publication Type
Article
Keywords
Aged
Early Detection of Cancer
Health Services Misuse
Humans
Male
Middle Aged
Proportional Hazards Models
Prostatectomy - statistics & numerical data - utilization
Prostatic Neoplasms - mortality - surgery
Risk
Survival Analysis
Sweden - epidemiology
Treatment Outcome
Abstract
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)
Notes
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PubMed ID
22927485 View in PubMed
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Interpreting data from randomized trials: the Scandinavian prostatectomy study illustrates two common errors.

https://arctichealth.org/en/permalink/ahliterature170737
Source
Nat Clin Pract Urol. 2005 Sep;2(9):404-5
Publication Type
Article
Date
Sep-2005
Author
Andrew Vickers
Author Affiliation
Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. vickersa@mskcc.org
Source
Nat Clin Pract Urol. 2005 Sep;2(9):404-5
Date
Sep-2005
Language
English
Publication Type
Article
Keywords
Bias (epidemiology)
Data Interpretation, Statistical
Humans
Male
Prostatectomy
Prostatic Neoplasms - mortality - surgery
Randomized Controlled Trials as Topic - statistics & numerical data
Scandinavia
PubMed ID
16474658 View in PubMed
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Length of life gained with surgical treatment of prostate cancer: A population-based analysis.

https://arctichealth.org/en/permalink/ahliterature272121
Source
Scand J Urol. 2015;49(4):275-81
Publication Type
Article
Date
2015
Author
Martin Andreas Røder
Klaus Brasso
Ea Rusch
Jørgen Johansen
Niels Christian Langkilde
Helle Hvarness
Steen Carlsson
Henrik Jakobsen
Michael Borre
Peter Iversen
Source
Scand J Urol. 2015;49(4):275-81
Date
2015
Language
English
Publication Type
Article
Keywords
Adult
Aged
Denmark
Humans
Kaplan-Meier Estimate
Longevity
Male
Middle Aged
Prostatectomy
Prostatic Neoplasms - mortality - surgery
Retrospective Studies
Treatment Outcome
Abstract
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.
PubMed ID
25438988 View in PubMed
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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?

https://arctichealth.org/en/permalink/ahliterature187269
Source
Harv Mens Health Watch. 2002 Dec;7(5):8
Publication Type
Article
Date
Dec-2002

[Organisation and early outcome after radical prostatectomy in Denmark 2004-2007]

https://arctichealth.org/en/permalink/ahliterature92244
Source
Ugeskr Laeger. 2008 Aug 18;170(34):2545-9
Publication Type
Article
Date
Aug-18-2008
Author
Borre Michael
Iversen Peter
Bendixen Anette
Iversen Maria Gerding
Kehlet Henrik
Author Affiliation
Universitetshospital, Skejby, Urinvejskirurgisk Afdeling, Rigshospitalet, Urologisk Afdeling.
Source
Ugeskr Laeger. 2008 Aug 18;170(34):2545-9
Date
Aug-18-2008
Language
Danish
Publication Type
Article
Keywords
Denmark - epidemiology
Humans
Length of Stay
Male
Outcome Assessment (Health Care)
Patient Readmission
Prostatectomy - adverse effects - methods - mortality - statistics & numerical data
Prostatic Neoplasms - mortality - surgery
Registries
Abstract
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.
PubMed ID
18761836 View in PubMed
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Patients undergoing radical prostatectomy have a better survival than the background population.

https://arctichealth.org/en/permalink/ahliterature114092
Source
Dan Med J. 2013 Apr;60(4):A4612
Publication Type
Article
Date
Apr-2013
Author
Martin Andreas Røder
Klaus Brasso
Kasper Drimer Berg
Frederik Birkebæk Thomsen
Lisa Gruschy
Ea Rusch
Peter Iversen
Author Affiliation
Copenhagen Prostate Cancer Center, Rigshospitalet, 2200 Copenhagen N, Denmark. andreasroder@gmail.com
Source
Dan Med J. 2013 Apr;60(4):A4612
Date
Apr-2013
Language
English
Publication Type
Article
Keywords
Aged
Bias (epidemiology)
Combined Modality Therapy
Denmark - epidemiology
Disease-Free Survival
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Prospective Studies
Prostate-Specific Antigen - blood
Prostatectomy
Prostatic Neoplasms - mortality - surgery - therapy
Survival Rate
Abstract
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.
not relevant.
PubMed ID
23651719 View in PubMed
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Postoperative mortality 90 days after robot-assisted laparoscopic prostatectomy and retropubic radical prostatectomy: a nationwide population-based study.

https://arctichealth.org/en/permalink/ahliterature282858
Source
BJU Int. 2016 Aug;118(2):302-6
Publication Type
Article
Date
Aug-2016
Author
Johan Björklund
Yasin Folkvaljon
Alexander Cole
Stefan Carlsson
David Robinson
Stacy Loeb
Pär Stattin
Olof Akre
Source
BJU Int. 2016 Aug;118(2):302-6
Date
Aug-2016
Language
English
Publication Type
Article
Keywords
Aged
Cohort Studies
Humans
Laparoscopy
Male
Middle Aged
Postoperative Period
Prostatectomy - methods - mortality
Prostatic Neoplasms - mortality - surgery
Robotic Surgical Procedures
Sweden
Time Factors
Abstract
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
Notes
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PubMed ID
26762928 View in PubMed
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14 records – page 1 of 2.