Natural history, and impact of surgery and radiation on survival outcomes of men diagnosed with low-grade prostate cancer at ≤ 55 years of age: a 25-year follow-up of > 60,000 men

• Published in: International urology and nephrology Vol. 55; no. 2; pp. 295 - 300
• Main Authors: Alam, Muhammad Umar, Kumar, Jatinder, Norez, Daniel, Woolfe, Jennifer, Tanneru, Karthik, Jazayeri, Seyed Behzad, Bazargani, Soroush, Thomas, Devon, Gautam, Shiva, Costa, Joseph, Bandyk, Mark, Ganapathi, Hariharan Palayapalayam, Koochekpour, Shahriar, Balaji, K. C.
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01-02-2023; Springer Nature B.V
• Subjects: Adult; Cancer surgery; Epidemiology; Follow-Up Studies; Humans; Male; Medicine; Medicine & Public Health; Mortality; Nephrology; Prostate; Prostate cancer; Prostate-Specific Antigen; Prostatectomy; Prostatectomy - methods; Prostatic Neoplasms - diagnosis; Prostatic Neoplasms - radiotherapy; Prostatic Neoplasms - surgery; Radiation therapy; Survival; Urological surgery; Urology; Urology - Original Paper; Young men; Long-term survival; Radical prostatectomy; Radiotherapy; Prostate cancer
• ISSN: 1573-2584; 0301-1623; 1573-2584
• DOI: 10.1007/s11255-022-03363-6

Purpose
Low-grade prostate cancer has low mortality rates at 10 years; however, it is unclear if the response is sustained for up to 25 years of follow-up.
Methods
Using Surveillance, Epidemiology, and End Results database, the overall and cancer-specific mortality rates were compared among men ≤ 55 years of age diagnosed with low-grade prostate cancer that either had radical prostatectomy, radiotherapy, or no known treatment.
Results
Of the 62,772 men diagnosed with low-grade prostate cancer between 1975 and 2016, about 60%, 20% and 20% of men underwent radical prostatectomy, radiotherapy, and no known treatment, respectively. At a median follow-up of 10 years, almost 2% and 7% of men died of prostate cancer and other causes, respectively. The overall mortality was significantly better in radical prostatectomy group compared to no known treatment group (HR 1.99, CI 1.84–2.15,
P
value < 0.001), but not between the radiotherapy and no known treatment groups. Moreover, the overall and cancer-specific mortality rates in the radiotherapy group were almost two and three times compared to the radical prostatectomy group, respectively (HR 2.15, CI 2.01–2.29,
P
value < 0.001 for overall mortality and HR 2.87, CI 2.5–3.29,
P
value < 0.001 for cancer-specific mortality).
Conclusions
The study confirms low mortality rates in men diagnosed with low-grade prostate cancer for over 25 years’ follow-up. While radical prostatectomy improves survival significantly compared to no known treatment, radiotherapy is associated with an increase in overall and cancer-specific mortality, which may be related to long-term toxicities.