BACKGROUND: Radical prostatectomy is traditionally reserved for men with a life-expectancy of at least 10 years.
Numerous studies have shown that survival estimates by physicians are inaccurate.
OBJECTIVE: Determine how well men undergoing radical prostatectomy for cancer are prognosticated by comparing their observed survival with expected survival.
DESIGN, SETTING, AND PARTICIPANTS: Observational cohort study using population-based datasets to identify every man in Ontario, Canada between 1992 and 2011 diagnosed with prostate cancer who underwent radical prostatectomy within 6 months.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Observed 10-year survival rates were calculated using Kaplan-Meier methods. Two expected 10-year survival rates were calculated using: population life-tables; and the Aggregated Diagnosis Group (ADG) Score, an accurate, validated index that predicts mortality risk based on patient comorbidities.
RESULTS AND LIMITATIONS: 36 045 men were included (median age 62, median observation time 8.1 years). The observed 10-year survival was 88.9% (95% CI 88.4-89.3%), significantly greater than expected 10-year survival of 83.3% by life-tables and 76.0% by the ADG Score. The observed to expected ratio of deaths was 0.66 (0.64-0.68) and 0.46 (0.45-0.48) using life-tables and the ADG Score, respectively. We are uncertain how these results apply to patients and physicians outside Ontario.
CONCLUSIONS: Ontario men undergoing radical prostatectomy for cancer have a 10-year survival that significantly exceeds the population and people with similar comorbidities. This indicates that physicians and patients involved in deciding who should undergo radical prostatectomy have done an excellent job at identifying prostate cancer patients with high survival.
Written by:
Lavallée LT, Manuel DC, van Walraven C. Are you the author?
Reference: J Urol. 2014 Apr 21. pii: S0022-5347(14)03422-3.
doi: 10.1016/j.juro.2014.04.087
PubMed Abstract
PMID: 24769026
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