INTRODUCTION: It is customary to consider deaths that occur within 90 days of surgery as caused by that surgery.
However, such practice may overestimate the true short-term mortality rates after radical prostatectomy (RP). Indeed, treatment-unrelated events might affect short-term mortality rates. We assess RP-specific excess short-term mortality.
METHODS: We performed a retrospective analysis of a population-based cohort of 59 010 patients (RP = 28 281 and external beam radiation therapy [EBRT] as reference group, n = 30 729) who were treated between 1998 and 2005 for non-metastatic prostate cancer. Using univariate and multivariate logistic regression analyses, we assessed the rates of 30-, 60- and 90-day mortality after either RP or EBRT.
RESULTS: Within the cohort, 30-, 60- and 90-day mortality rates were 0.2, 0.5 and 0.6%, and 0.1, 0.4 and 0.6% for RP and EBRT patients, respectively. This resulted in overall 30-, 60, and 90- day mortality differences of 0.1, 0.1 and 0%, respectively. After stratification according to age and Charlson comorbidity index (CCI), the magnitude of these differences increased up to 3.2% in favour of EBRT in patients aged >75 years with CCI ≥2. In multivariable analysis, rates of 30-, 60- and 90- day mortality were 5.2-, 1.8- and 1.3-fold higher after RP than EBRT, respectively. Our study is limited by its non-randomized design.
CONCLUSION: Overall, absolute short-term mortality rates after RP are comparable to those of EBRT. The difference decreases over time: 90 days < 60 days < 30 days. Nonetheless, their magnitude is far from trivial in the elderly and sickest patients.
Written by:
Hansen J, Gandaglia G, Bianchi M, Sun M, Rink M, Tian Z, Meskawi M, Trinh QD, Shariat SF, Perrotte P, Chun FK, Graefen M, Karakiewicz PI. Are you the author?
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC; Martini Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Vita-Salute San Raffaele University, Milan, Italy; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC; Department of Urology, University of Montreal Health Centre, Montreal, QC; Department of Urology, Weill Medical College of Cornell University, New York, NY; Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI; University Hospital Hamburg-Eppendorf, Hamburg, Germany; Martini Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University of Montreal Health Centre, Montreal, QC.
Reference: Can Urol Assoc J. 2014 Jan;8(1-2):E75-80.
doi: 10.5489/cuaj.749
PubMed Abstract
PMID: 24554978
UroToday.com Prostate Cancer Section
