Prostate cancer prognosis in men with other malignancies prior to radical prostatectomy

Peter Klippenstein; Thorsten Schlomm; Gunhild von Amsberg; Burkhard Beyer; Raisa S Pompe; Uwe Michl; Georg Salomon; Imke Thederan; Lars Budäus; Hans Heinzer; Derya Tilki; Alexander Haese; Hartwig Huland; Markus Graefen; Thomas Steuber; Pierre Tennstedt

doi:10.1016/j.urolonc.2019.04.007

Prostate cancer prognosis in men with other malignancies prior to radical prostatectomy

Urol Oncol. 2019 Sep;37(9):575.e1-575.e7. doi: 10.1016/j.urolonc.2019.04.007. Epub 2019 Apr 30.

Authors

Affiliations

¹ Martini-Klinik, Prostate Cancer Center, Medical University Hamburg Eppendorf, Hamburg, Germany.
² Clinic of Oncology, Haematology and Bone Marrow Transplant, Medical University Hamburg Eppendorf, Hamburg, Germany.
³ Martini-Klinik, Prostate Cancer Center, Medical University Hamburg Eppendorf, Hamburg, Germany. Electronic address: p.tennstedt@uke.de.

PMID: 31047783
DOI: 10.1016/j.urolonc.2019.04.007

Abstract

Objectives: Cancer survivors are often diagnosed with subsequent prostate cancer. To improve medical care of these patients, we examined the oncological outcomes in men with prostate cancer and a cancer history.

Patients and methods: We retrospectively analyzed data from 25,422 prostate cancer patients, who underwent a radical prostatectomy between 1992 and 2016. Patients with other malignancies were identified using medical records and self-administrated questionnaires. Cox regression and Kaplan Meier analysis of a propensity score-matched patient cohort were performed to examine biochemical recurrence-free survival, metastasis-free survival, overall survival and prostate cancer-specific survival. Competing risk analysis was used to estimate other-cause mortality, other cancer-specific mortality, and prostate cancer-specific mortality. Statistical analysis was performed using R.

Results: Of all patients, 6.4% were diagnosed with other malignancy prior to radical prostatectomy. Patients with tumor history were older (median: 66 years vs. 64 years., P< 0,001) and showed a higher tumor volume (median: 4.0 ml vs. 3.6 ml, P = 0.02) than patients without. The risk of biochemical recurrence and metastasis development after radical prostatectomy was similar. All-cause mortality was significantly increased (hazard ratio 2.0; 95% confidence interval 1.7-2.4), while prostate cancer-specific mortality was lower (hazard ratio 0.4; 95% confidence interval 0.23-0.87) in patients with additional malignancy. In a propensity score-matched cohort overall survival was significantly adverse (P< 0.001) and prostate cancer-specific survival was higher (P= 0.003) in patients with other malignancy prior to surgery.

Conclusion: A higher other-cause mortality in men with tumor history should be concerned in the decision-making for medical care of prostate cancer patients in favor of reserved care strategies.

Keywords: All-cause mortality; Cancer-specific mortality; Competing risk; Multiple primary neoplasms; Prostate cancer; Radical prostatectomy.

MeSH terms

Adult
Aged
Aged, 80 and over
Humans
Male
Middle Aged
Prognosis
Prostatectomy / methods*
Prostatic Neoplasms / surgery*
Retrospective Studies