SURVIVAL AFTER RADICAL PROSTATECTOMY

Context.-The generalizability of currently available estimates of surv ival after radical prostatectomy is theoretically limited. Objective.- To obtain generalizable estimates of survival after radical prostatect omy. Design.-A population-based retrospective cohort study. Setting.-N ine regions of the United States. Patients.-Patients who were diagnose d with prostate cancer between 1983 and 1987 and underwent radical pro statectomy and lymph node dissection. Main Outcome Measures-Proportion al hazards models incorporating geographical region, age, race, pathol ogical stage, lymph node involvement, and tumor grade to identify inde pendent correlates of disease-specific and overall survival and life t able analyses to estimate 10-year survival distributions. Results.-A t otal of 3626 patients with a mean age of 65 years were included in the study; 92.6% were white, 54.2% had moderate-grade cancer, 60.4% had n o extension beyond the prostate, and 91.2% had no lymph node involveme nt. Using San Francisco-Oakland, Calif, as a reference region, no othe r region was significantly associated with a risk of disease-specific or overall mortality. Older age and black race were independently asso ciated with worse overall but not disease-specific survival. Higher gr ade, extension beyond the prostate, and lymph node involvement were in dependently associated with worse disease-specific and overall surviva l. Estimates of 10-year disease-specific survival ranged from 75% to 9 7% for patients with well-differentiated and moderately differentiated cancers and from 60% to 86% for patients with poorly differentiated c ancers. Conclusions.-Neither disease-specific nor overall survival var ied by region, suggesting geographically uniform assessments of risk i n patient selection for radical prostatectomy. Across regions, overall survival varied by patient and prostate cancer characteristic while d isease-specific survival varied substantially by prostate cancer but n ot patient characteristics. The present analyses provide the most gene ralizable current estimates of survival after radical prostatectomy.