title: Impact of age and comorbidities on long-term survival of patients with high-risk prostate cancer treated with radical prostatectomy: a multi-institutional competing-risks analysis.
abstract: BACKGROUND
  Survival after surgical treatment using competing-risk analysis has been previously examined in patients with prostate cancer (PCa). However, the combined effect of age and comorbidities has not been assessed in patients with high-risk PCa who might have heterogeneous rates of competing mortality despite the presence of aggressive disease.
  
  
  OBJECTIVE
  To examine the risk of 10-yr cancer-specific mortality (CSM) and other-cause mortality (OCM) according to clinical and pathologic characteristics of patients treated with radical prostatectomy (RP) for high-risk PCa.
  
  
  METHODS
  Within a multi-institutional cohort, 3828 men treated with RP for high-risk PCa (defined as the presence of at least one of these risk factors: prostate-specific antigen >20 ng/ml, biopsy Gleason score 8-10, clinical stage ≥ T3) were identified.
  
  
  METHODS
  All patients underwent RP and pelvic lymph node dissection.
  
  
  METHODS
  Competing-risk Poisson regression analyses were performed to simultaneously assess the 10-yr CSM and OCM rates after RP. The same analyses were also conducted after stratification of patients according to age at surgery, comorbidity status assessed by the Charlson Comorbidity Index (CCI), and number of risk factors (one vs two or more).
  
  
  CONCLUSIONS
  Overall, 229 patients (5.9%) died from PCa; 549 (14.3%) died from other causes. The 10-yr CSM and OCM rates ranged from 5.1% to 12.8% and from 4.3% to 37.4%, respectively. Age and CCI were the major determinants of OCM; their impact on CSM was minimal. OCM was the leading cause of death in all patient groups except in young men (≤ 59 yr) with no comorbidities, regardless of the number of risk factors (10-yr CSM and OCM 6.9-12.8% and 5.5-6.3%, respectively). The main limitation was the lack of patients managed conservatively.
  
  
  CONCLUSIONS
  Even in the context of high-risk PCa, long-term CSM after RP is modest and represents the leading cause of death only in young, healthy patients. Conversely, older and sicker patients with multiple risk factors are at the highest risk of dying from OCM while sharing very low CSM rates.
authors.affiliation: Department of Urology, Vita Salute University, San Raffaele Scientific Institute, Milan, Italy. briganti_alberto@yahoo.it
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
authors.forename: Martin
authors.initials: M
authors.lastname: Spahn
authors.forename: Steven
authors.initials: S
authors.lastname: Joniau
authors.forename: Paolo
authors.initials: P
authors.lastname: Gontero
authors.forename: Marco
authors.initials: M
authors.lastname: Bianchi
authors.forename: Burkhard
authors.initials: B
authors.lastname: Kneitz
authors.forename: Felix K H
authors.initials: FK
authors.lastname: Chun
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.forename: Markus
authors.initials: M
authors.lastname: Graefen
authors.forename: Firas
authors.initials: F
authors.lastname: Abdollah
authors.forename: Giansilvio
authors.initials: G
authors.lastname: Marchioro
authors.forename: Detlef
authors.initials: D
authors.lastname: Frohenberg
authors.forename: Simone
authors.initials: S
authors.lastname: Giona
authors.forename: Bruno
authors.initials: B
authors.lastname: Frea
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Hein
authors.initials: H
authors.lastname: Van Poppel
authors.forename: R
authors.initials: R
authors.lastname: Jeffrey Karnes
mesh_terms: D000367:Age Factors; D000368:Aged; D002423:Cause of Death; D015897:Comorbidity; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000601:surgery*; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome