No AccessJournal of UrologyAdult Urology1 Mar 2011Predicting 15-Year Prostate Cancer Specific Mortality After Radical Prostatectomy Scott E. Eggener, Peter T. Scardino, Patrick C. Walsh, Misop Han, Alan W. Partin, Bruce J. Trock, Zhaoyong Feng, David P. Wood, James A. Eastham, Ofer Yossepowitch, Danny M. Rabah, Michael W. Kattan, Changhong Yu, Eric A. Klein, and Andrew J. Stephenson Scott E. EggenerScott E. Eggener Section of Urology, University of Chicago Medical Center, Chicago, Illinois , Peter T. ScardinoPeter T. Scardino Urology Service, Department of Surgery, Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, New York , Patrick C. WalshPatrick C. Walsh James Buchanan Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, Maryland , Misop HanMisop Han James Buchanan Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, Maryland , Alan W. PartinAlan W. Partin James Buchanan Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, Maryland , Bruce J. TrockBruce J. Trock James Buchanan Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, Maryland , Zhaoyong FengZhaoyong Feng James Buchanan Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, Maryland , David P. WoodDavid P. Wood Department of Urology, University of Michigan, Ann Arbor, Michigan , James A. EasthamJames A. Eastham Urology Service, Department of Surgery, Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, New York , Ofer YossepowitchOfer Yossepowitch Rabin Medical Center, Petach Tikvah, Israel , Danny M. RabahDanny M. Rabah Division of Urology, Department of Surgery, Princess Johara Alibrahim Center for Cancer Research, King Saud University, Riyadh, Saudi Arabia , Michael W. KattanMichael W. Kattan Cleveland Clinic, Cleveland, Ohio , Changhong YuChanghong Yu Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio , Eric A. KleinEric A. Klein Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio , and Andrew J. StephensonAndrew J. Stephenson Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio View All Author Informationhttps://doi.org/10.1016/j.juro.2010.10.057AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Long-term prostate cancer specific mortality after radical prostatectomy is poorly defined in the era of widespread screening. An understanding of the treated natural history of screen detected cancers and the pathological risk factors for prostate cancer specific mortality are needed for treatment decision making. Materials and Methods: Using Fine and Gray competing risk regression analysis we modeled clinical and pathological data, and followup information on 11,521 patients treated with radical prostatectomy at a total of 4 academic centers from 1987 to 2005 to predict prostate cancer specific mortality. The model was validated on 12,389 patients treated at a separate institution during the same period. Median followup in the modeling and validation cohorts was 56 and 96 months, respectively. Results: The overall 15-year prostate cancer specific mortality rate was 7%. Primary and secondary Gleason grade 4–5 (each p <0.001), seminal vesicle invasion (p <0.001) and surgery year (p = 0.002) were significant predictors of prostate cancer specific mortality. A nomogram predicting 15-year prostate cancer specific mortality based on standard pathological parameters was accurate and discriminating with an externally validated concordance index of 0.92. When stratified by patient age at diagnosis, the 15-year prostate cancer specific mortality rate for pathological Gleason score 6 or less, 3 + 4, 4 + 3 and 8–10 was 0.2% to 1.2%, 4.2% to 6.5%, 6.6% to 11% and 26% to 37%, respectively. The 15-year prostate cancer specific mortality risk was 0.8% to 1.5%, 2.9% to 10%, 15% to 27% and 22% to 30% for organ confined cancer, extraprostatic extension, seminal vesicle invasion and lymph node metastasis, respectively. Only 3 of 9,557 patients with organ confined, pathological Gleason score 6 or less cancer died of prostate cancer. Conclusions: Poorly differentiated cancer and seminal vesicle invasion are the prime determinants of prostate cancer specific mortality after radical prostatectomy. The prostate cancer specific mortality risk can be predicted with remarkable accuracy after the pathological features of prostate cancer are known. 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Volume 185Issue 3March 2011Page: 869-875 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.Keywordsmortalityprostatectomyprostatic neoplasmsnomogramsprostateMetricsAuthor Information Scott E. Eggener Section of Urology, University of Chicago Medical Center, Chicago, Illinois Financial interest and/or other relationship with Visualase. More articles by this author Peter T. Scardino Urology Service, Department of Surgery, Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, New York More articles by this author Patrick C. Walsh James Buchanan Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, Maryland More articles by this author Misop Han James Buchanan Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, Maryland More articles by this author Alan W. Partin James Buchanan Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, Maryland More articles by this author Bruce J. Trock James Buchanan Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, Maryland More articles by this author Zhaoyong Feng James Buchanan Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, Maryland More articles by this author David P. Wood Department of Urology, University of Michigan, Ann Arbor, Michigan Financial interest and/or other relationship with Intuitive Surgical, Urotoday and Amgen. More articles by this author James A. Eastham Urology Service, Department of Surgery, Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, New York More articles by this author Ofer Yossepowitch Rabin Medical Center, Petach Tikvah, Israel More articles by this author Danny M. Rabah Division of Urology, Department of Surgery, Princess Johara Alibrahim Center for Cancer Research, King Saud University, Riyadh, Saudi Arabia More articles by this author Michael W. Kattan Cleveland Clinic, Cleveland, Ohio More articles by this author Changhong Yu Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio More articles by this author Eric A. Klein Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio More articles by this author Andrew J. Stephenson Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio More articles by this author Expand All Advertisement PDF downloadLoading ...