title: Predicting prostate cancer-specific outcome after radical prostatectomy among men with very high-risk cT3b/4 PCa: a multi-institutional outcome study of 266 patients.
abstract: BACKGROUND
  The value of radical prostatectomy (RP) as an approach for very high-risk prostate cancer (PCa) patients is controversial. To examine the risk of 10-year cancer-specific mortality (CSM) and other-cause mortality (OCM) according to clinical and pathological characteristics of very high-risk cT3b/4 PCa patients treated with RP as the primary treatment option.
  
  
  METHODS
  In a multi-institutional cohort, 266 patients with very high-risk cT3b/4 PCa treated with RP were identified. All patients underwent RP and pelvic lymph-node dissection. Competing-risk analyses assessed 10-year CSM and OCM before and after stratification for age and Charlson comorbidity index (CCI).
  
  
  RESULTS
  Overall, 34 (13%) patients died from PCa and 73 (28%) from OCM. Ten-year CSM and OCM rates ranged from 5.6% to 12.9% and from 10% to 38%, respectively. OCM was the leading cause of death in all subgroups. Age and comorbidities were the main determinants of OCM. In healthy men, CSM rate did not differ among age groups (10-year CSM rate for ⩽64, 65-69 and ⩾70 years: 16.2%, 11.5% and 17.1%, respectively). Men with a CCI ⩾1 showed a very low risk of CSM irrespective of age (10-year CSM: 5.6-6.1%), whereas the 10-year OCM rates increased with age up to 38% in men ⩾70 years.
  
  
  CONCLUSIONS
  Very high-risk cT3b/4 PCa represents a heterogeneous group. We revealed overall low CSM rates despite the highly unfavorable clinical disease. For healthy men, CSM was independent of age, supporting RP even for older men. Conversely, less healthy patients had the highest risk of dying from OCM while sharing very low risk of CSM, indicating that this group might not benefit from an aggressive surgical treatment. Outcome after RP as the primary treatment option in cT3b/4 PCa patients is related to age and comorbidity status.
authors.affiliation: Department of Urology, University Hospital Bern, Bern, Switzerland.
authors.forename: F
authors.initials: F
authors.lastname: Moltzahn
authors.affiliation: Department of Urology, Mayo Clinic Rochester, Rochester, MN, USA.
authors.forename: J
authors.initials: J
authors.lastname: Karnes
authors.affiliation: Department of Urology, University of Turin, Turin, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Gontero
authors.affiliation: Department of Urology and Pediatric Urology, University Hospital Wurzburg, Wurzburg, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Kneitz
authors.affiliation: Department of Urology, Université Catholique De Louvain, Brussels, Belgium.
authors.forename: B
authors.initials: B
authors.lastname: Tombal
authors.affiliation: Department of Urology, Community Hospital Karlsruhe, Karlsruhe, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Bader
authors.affiliation: Department of Urology, Hospital San Rafael, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Briganti
authors.affiliation: Department of Urology, Hospital San Rafael, Milan, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Montorsi
authors.affiliation: Department of Urology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: H
authors.initials: H
authors.lastname: Van Poppel
authors.affiliation: Department of Urology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: S
authors.initials: S
authors.lastname: Joniau
authors.affiliation: Department of Urology, University Hospital Bern, Bern, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Spahn
mesh_terms: D000367:Age Factors; D000368:Aged; D015897:Comorbidity; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000473:pathology; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D017430:Prostate-Specific Antigen