September 15, 2015
Scandinavian Journal of Urology
TAKE-HOME MESSAGE
- There is ongoing controversy regarding the degree to which surgery helps overall survival in men with prostate cancer. The authors of this retrospective study evaluated the effect of radical prostatectomy, using data from 6489 men undergoing prostatectomy in Denmark between 1995 and 2011. The median follow-up was 4 years. Approximately 20% of the men were D’Amico low-risk, 50% were intermediate-risk, and the remaining men were high-risk or not classified. The authors defined relative survival as the ratio of the observed survival and the estimated survival based on all-cause death rates. At 10 years, the relative gain in life of patients undergoing prostatectomy was 0.41 years (D’Amico low, 0.56 years; intermediate, 0.42 years; high, 0.31 years).
- This study represents a nationwide estimate of survival benefits from radical prostatectomy. Importantly, the reader must be cautioned that there are notable limitations, in addition to lead-time and selection biases. The authors note that there was improved survival in men undergoing prostatectomy more recently, suggesting a change in surgical technique, although this is not addressed further. In addition, survival benefit is based on expected survival, which is estimated survival based on all-cause mortality. A more appropriate comparison may be men who refused surgery. Finally, it is not clear what adjuvant or salvage treatments were given to these men. As a result, the authors of this study assert that there is a minimal benefit to prostatectomy; however, further analysis needs to be performed to support this claim.
Abstract
OBJECTIVE
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.
MATERIAL AND METHODS
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.
RESULTS
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.
CONCLUSION
This population-based study demonstrated that the gain in life expectancy with RP compared with the general population in Denmark is minimal.