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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Predicting 15-year prostate cancer specific mortality after radical prostatectomy
Journal of Urology, Volume 185, No. 3, Year 2011
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Description
Purpose Long-term prostate cancer specific mortality after radical prostatectomy is poorly defined in the era of widespread screening. An understanding of the treated natural history of screen detected cancers and the pathological risk factors for prostate cancer specific mortality are needed for treatment decision making. Materials and Methods Using Fine and Gray competing risk regression analysis we modeled clinical and pathological data, and followup information on 11,521 patients treated with radical prostatectomy at a total of 4 academic centers from 1987 to 2005 to predict prostate cancer specific mortality. The model was validated on 12,389 patients treated at a separate institution during the same period. Median followup in the modeling and validation cohorts was 56 and 96 months, respectively. Results The overall 15-year prostate cancer specific mortality rate was 7%. Primary and secondary Gleason grade 45 (each p <0.001), seminal vesicle invasion (p <0.001) and surgery year (p = 0.002) were significant predictors of prostate cancer specific mortality. A nomogram predicting 15-year prostate cancer specific mortality based on standard pathological parameters was accurate and discriminating with an externally validated concordance index of 0.92. When stratified by patient age at diagnosis, the 15-year prostate cancer specific mortality rate for pathological Gleason score 6 or less, 3 + 4, 4 + 3 and 810 was 0.2% to 1.2%, 4.2% to 6.5%, 6.6% to 11% and 26% to 37%, respectively. The 15-year prostate cancer specific mortality risk was 0.8% to 1.5%, 2.9% to 10%, 15% to 27% and 22% to 30% for organ confined cancer, extraprostatic extension, seminal vesicle invasion and lymph node metastasis, respectively. Only 3 of 9,557 patients with organ confined, pathological Gleason score 6 or less cancer died of prostate cancer. Conclusions Poorly differentiated cancer and seminal vesicle invasion are the prime determinants of prostate cancer specific mortality after radical prostatectomy. The prostate cancer specific mortality risk can be predicted with remarkable accuracy after the pathological features of prostate cancer are known. © 2011 American Urological Association Education and Research, Inc.
Authors & Co-Authors
Eggener, Scott E.
United States, Chicago
The University of Chicago Medicine
Scardino, Peter T.
United States, New York
Memorial Sloan-kettering Cancer Center
Walsh, Patrick Craig
United States, Baltimore
Johns Hopkins School of Medicine
Han, Misop
United States, Baltimore
Johns Hopkins School of Medicine
Partin, Alan Wayne
United States, Baltimore
Johns Hopkins School of Medicine
Trock, Bruce J.
United States, Baltimore
Johns Hopkins School of Medicine
Feng, Zhaoyong
United States, Baltimore
Johns Hopkins School of Medicine
Wood, David P.
United States, Ann Arbor
University of Michigan, Ann Arbor
Eastham, James A.
United States, New York
Memorial Sloan-kettering Cancer Center
Yossepowitch, Ofer
Israel, Petah Tiqwa
Rabin Medical Center Israel
Rabah, Danny M.
Saudi Arabia, Riyadh
King Saud University
Kattan, Michael W.
United States, Cleveland
Cleveland Clinic Foundation
Yu, Changhong
United States, Cleveland
Cleveland Clinic Foundation
Klein, Eric A.
United States, Cleveland
Cleveland Clinic Foundation
Stephenson, Andrew J.
United States, Cleveland
Cleveland Clinic Foundation
Statistics
Citations: 618
Authors: 15
Affiliations: 7
Identifiers
Doi:
10.1016/j.juro.2010.10.057
ISSN:
00225347
Research Areas
Cancer
Health System And Policy
Study Design
Cohort Study
Study Approach
Quantitative