Long-term overall survival of radical prostatectomy patients is often superior to the general population: A comparison using life-table data.
BACKGROUND
To examine overall survival rates within a large cohort of German prostate cancer (PCa) patients and to compare these with life-expectancy (LE) predictions derived from German life tables. We hypothesized that the advantage of good general health in radical prostatectomy (RP) patients combined with favorable cancer outcomes might lead to even higher overall survival rates over 10 years compared to the LE of a general population.


METHODS
A total of 6483 patients were treated with RP between 1992 and 2007 at the Martini-Klinik Prostate Cancer Center. Preoperative risk classification was performed according to D'Amico. Postoperative risk classification was performed according to the Cancer of the Prostate Risk Assessment score (CAPRA-S). A simulated cohort was created that resembled the exact age distribution of the RP population using Monte Carlo simulation which was based on data derived from official male German life tables (1992-2017). Markov chain was used to represent natural age progression of the simulated cohort. Kaplan-Meier plots were created to display the differences between 10-year observed overall survival (OS) and the simulated, predicted LE.


RESULTS
For D'Amico low risk and intermediate risk, 10-year OS was 12.0% and 9.2% above predicted LE in the simulated cohort, respectively. For D'Amico high risk, OS was virtually the same as predicted LE (0.8% difference in favor of RP treated patients). For CAPRA-S low and intermediate risk, OS was 11.8% and 9.7% above predicted LE. For CAPRA-S high risk, OS was virtually the same as predicted LE (0.3% difference in favor of the simulated cohort).


CONCLUSIONS
Low- and intermediate risk PCa patients treated with RP can expect a very favorable overall survival, that even exceeds LE predictions. High risk patients' overall survival perfectly aligns with LE predictions.
['Würnschimmel|Christoph|C|https://orcid.org/0000-0001-7891-4791', 'Wenzel|Mike|M|https://orcid.org/0000-0002-4338-0889', 'Wang|Nuowei|N|', 'Tian|Zhe|Z|', 'Karakiewicz|Pierre I|PI|', 'Graefen|Markus|M|', 'Huland|Hartwig|H|', 'Tilki|Derya|D|']
survival radical prostatectomy prostate cancer life-expectancy life table