Surgery News - April 2008 - (Page 11)

APRIL 2008 • SURGERY NEWS UROLOGY 11 Radical Prostatectomy Confers 15-Year Mortality Benefit B Y S H E R RY B O S C H E R T Else vier Global Medical Ne ws S A N F R A N C I S C O — Men diagnosed with prostate cancer in the era of prostatespecific antigen screening and treated with radical prostatectomy are unlikely to die of the disease, even if they have adverse risk factors, a review of 6,398 patients found. The patients were treated between 1987 and 2005, and had a 15-year risk of dying of prostate cancer of 12%. Their 15-year all-cause mortality rate was 38%, Dr. Andrew J. Stephenson reported at a symposium on genitourinary cancers. The retrospective study was described as the first to assess disease-specific mortality risk in the era of prostate-specific antigen (PSA) screening. The favorable prognosis may be a result of the effectiveness of prostatectomy or could reflect a lower degree of lethality in most screen-detected prostate cancers, said Dr. Stephenson The 15-year risk of of the Cleveland Clinic Foundation, dying of prostate and his associates. cancer was 19% Prior to the PSA in patients era, 15%-20% of paclassified as tients treated with having high risk. radical prostatectoDR. STEPHENSON my died of prostate cancer within the 10-15 years after treatment, population-based studies showed. “I think that this is important information for patients and physicians to consider when deciding upon treatment options for localized prostate cancer,” he said. “Even patients who have an extremely low probability of cure based on a PSA criterion [PSA recurrence] still have an excellent chance of being alive 15 years after radical prostatectomy.” Only 13% of patients had a greater than 5% risk of dying of prostate cancer within 15 years. Among patients treated since 1998, only 3% had a greater than 5% risk of prostate-specific mortality, Dr. Stephenson reported. Risk of dying of prostate cancer ranged from 5% to 37% for patients in the lowest and highest quartiles of risk for a PSA-defined recurrence as predicted by a nomogram that was developed by the investigators and was based on five clinical characteristics, with predictions adjusted for the year of surgery. The 6,398 patients were in a prediction modeling cohort; all had been treated by radical prostatectomy at Memorial SloanKettering Cancer Center, New York, or at Baylor College of Medicine, Houston, during 1987-2005. The investigators also performed external validation of the modeling by applying it to retrospective data on 4,103 patients treated by radical prostatectomy at the Cleveland Clinic during 1989-2005. In the modeling cohort, 2% of patients died of prostate cancer and 5% died of competing causes. In the validation cohort, 2% died of prostate cancer and 6% died of competing causes. The median fol- low-up in both cohorts was 48 months. The predicted risk closely matched observed outcomes. Factors that were significantly associated with prostate-specific mortality included the biopsy Gleason grade, preoperative PSA level, clinical stage, use of neoadjuvant androgen deprivation therapy, and year of surgery. Surgery in more recent years was associated with improvements in survival until 1998, after which the favorable impact leveled off. PSA velocity and body mass index were not associated with the risk of dying of prostate cancer. The investigators looked further at survival by risk stratification in 9,481 patients with data using the D’Amico criteria. These criteria for assessing the risk of PSA recurrence after treatment of prostate cancer were described by Dr. Anthony V. D’Amico of Harvard Medical School, Boston ( JAMA 1998;280:969-74). Dr. Stephenson reported the 19% of patients classified as high risk comprised 79% of cancer deaths (and all cancer deaths since 1998). The 15-year risk of dy- ing of prostate cancer in this high-risk subgroup was 19%, compared with a 31% risk of dying from competing causes, he said. The 15-year prostate-specific mortality rate was 10% among patients classified as having intermediate risk of recurrence by D’Amico criteria, and 2% among patients with a good risk profile. The symposium was sponsored by the American Society of Clinical Oncology, American Society for Therapeutic Radiology and Oncology, and the Society of Urologic Oncology. New InfoV.A.C. Therapy System ® Better by Design The Next Generation of V.A.C.® Therapy The InfoV.A.C.® Therapy System delivers the same positive outcomes you trust – but is now simpler and more efficient than ever.* Easier to Use. Designed with busy clinicians in mind. Simpler Training. Designed to be easier to learn, improving proficiency. Better Information. Designed to provide consistent wound progress tracking. Better by Design www.InfoVACTherapy.com • 1-800-275-4524 *As compared to V.A.C. ATS® Therapy Note: Specific indications, contraindications, warnings, precautions, and safety tips exist for this product and therapy. Please consult Product Instructions for Use prior to applications. ©2008 KCI Licensing, Inc. All rights reserved. KCI USA, 8023 Vantage Drive, San Antonio, TX 78230. All trademarks and service marks designated herein are the property of KCI and its affiliates and licensors. The V.A.C.® (Vacuum Assisted Closure®) System and most KCI products are subject to patents and/or pending patents. http://www.InfoVACTherapy.com http://www.InfoVACTherapy.com

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Surgery News - April 2008

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