Treatment and 5-year survival in patients with nonmetastatic prostate cancer: the Norwegian experience.
OBJECTIVE
To establish the 5-year overall and prostate cancer-specific survival in 3486 patients with a new diagnosis of nonmetastatic prostate cancer recorded in the Norwegian Prostate Cancer Registry in 2004-2005.


METHODS
The eligible patients were ≤75 years old and had undergone radical prostatectomy (n = 895), high-dose radiotherapy with or without adjuvant hormonal therapy (n = 1339), or no local treatment (n = 1252). Kaplan-Meier estimates, Cox regression analyses, and competing risk methods were used.


RESULTS
For all patients, the overall and prostate cancer-specific survival was 89.8% (95% confidence interval 88.8-90.8) and 96.5% (95% confidence interval 95.9-97.1), respectively. Less than 1% of the 76 deaths in patients with low-risk tumors were from prostate cancer. Among the patients with high-risk tumors in the no local treatment group, 48% of the 207 deaths were from prostate cancer compared with 33% of the 81 deaths in the radical prostatectomy and radiotherapy groups (P = .03). On multivariate analysis, local treatment (yes vs no), tumor risk category, and performance status were independently associated with prostate cancer survival, but age was not. No significant differences emerged between the radical prostatectomy and radiotherapy groups. A lack of local treatment and a reduced performance status were significantly associated with reduced prostate cancer-specific survival.


CONCLUSIONS
Although based on only 5 years of observation, we have concluded that patients with low-risk tumors should be informed about the option of active surveillance. Patients with high-risk tumors run a risk of undertreatment if local treatment is not applied. The correct identification of tumor risk categories and comorbidity at the diagnosis of nonmetastatic prostate cancer remains a challenge for clinicians.
Department of Oncology, Oslo University Hospital, Radiumhospital, Oslo, Norway; Cancer Registry of Norway, Oslo, Norway. Electronic address: sdf@ous-hf.no.
Sophie D
SD
Fosså
Cancer Registry of Norway, Oslo, Norway.
Yngvar
Y
Nilssen
Cancer Registry of Norway, Oslo, Norway.
Rune
R
Kvåle
Department of Oncology, Oslo University Hospital, Radiumhospital, Oslo, Norway.
Eivor
E
Hernes
Department of Urology, Oslo University Hospital, Radiumhospital, Oslo, Norway.
Karel
K
Axcrona
Cancer Registry of Norway, Oslo, Norway.
Bjørn
B
Møller
D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000628:therapy*; D015996:Survival Rate; D013997:Time Factors