10-Year Mortality After Radical Prostatectomy for Localized Prostate Cancer in the Prostate-specific Antigen Screening Era

Objective: To provide insight into the impact of radical prostatectomy (RP) on prostate cancer-specific mortality (PCSM) in a primarily prostate-specific antigen screen-detected cohort of men with localized prostate cancer (PCa).

Methods: Between 2000 and 2013, 1864 men consented to participate in a prospective longitudinal outcomes study after RP for localized PCa by a single surgeon. Men lost to follow-up were queried to the National Death Index to acquire mortality data.

Results: From our cohort of 1864 men (median age 59 years, median preoperative prostate-specific antigen 5.0, median follow-up 9.1 years), Kaplan-Meier analysis demonstrated 10-year all-cause mortality and PCSM of 4.6% and 1.4%, respectively. Ten-year PCSM for low, intermediate, and high D'Amico risk were 0.9%, 1.0%, and 7.4%, respectively (P <.001). For men with postoperative Gleason score 4-6, 7, and 8-10, 10-year PCSM was 0.8%, 1.0%, and 11.5%, respectively (P <.001). Men with pT2, pT3a, and pT3b disease had 10-year PCSM of 0.7%, 2.6%, and 9.5%, respectively (P <.001). Pathologic stage and grade were the only significant independent predictor of PCSM at 10 years (P = .002 and P = .025, respectively).

Conclusion: In our series with up to 13 years of follow-up from the National Death Index, 10-year PCSM after RP for clinically localized PCa was very low and strongly predicted by pathologic stage and grade. Death unrelated to PCa was a rare event, suggesting that we are identifying candidates for RP who are likely to live long enough to benefit from surgical intervention.