25-Year Prostate Cancer Control and Survival Outcomes: A 40-Year Radical Prostatectomy Single Institution Series

Purpose

We report on 25-year cancer control and survival outcomes after radical prostatectomy in a single center series of patients treated during a 40-year period.

Materials and Methods

Between 1954 and 1994, 787 consecutive patients underwent radical prostatectomy at Virginia Mason Medical Center in Seattle, Washington. Kaplan-Meier 25-year probabilities of prostate cancer specific, overall, prostate specific antigen progression-free, local and distant progression-free survival were determined. Multivariate Cox regression models addressed prostate cancer specific mortality.

Results

Prostate cancer specific survival, overall survival, prostate specific antigen progression-free survival, local and distant progression-free survival ranged from 99.0% to 81.5%, 93.5% to 19.3%, 84.8% to 54.5%, 95.3% to 87.8% and 95.9% to 78.2%, respectively. In univariate analyses pathological stage, surgical margin status, pathological Gleason sum, delivery of hormonal therapy and radiotherapy represented statistically significant predictors of prostate cancer specific mortality (all p ≤0.001). In multivariate analyses only Gleason sum (p = 0.03) and delivery of hormonal therapy (p <0.001) remained significant.

Conclusions

This is one of the most mature radical prostatectomy series. It demonstrates that long-term biochemical cancer control outcomes after radical prostatectomy might be suboptimal. However, local and distant control outcomes are excellent, and cancer specific mortality is minimal even 25 years after surgery.

Key Words:  prostatic neoplasms , prostatectomy , outcome assessment , survival analysis

Abbreviations and Acronyms:  AJCC, American Joint Committee on Cancer , PCA, prostate cancer , PCSS, prostate cancer specific survival , PLND, pelvic lymph node dissection , PSA, prostate specific antigen , RP, radical prostatectomy , RPP, radical perineal prostatectomy , RRP, radical retropubic prostatectomy , VMMC, Virginia Mason Medical Center