Catalona’s Failure Rate

Urologist Dr. William J. Catalona performed the radical prostatectomy for prostate cancer on 3,478 men for prostate cancer between May 1983 and February 2003.

Actuarial 10-year probabilities of 1) biochemical progression-free survival, 2) cancer specific survival, and 3) overall survival were calculated after and average (mean) follow-up of 5.4 years.

Ten-year biochemical progression-free survival was estimated to be 68%.
Ten-year cancer-specific survival was estimated to be 97%.
Ten-year overall survival was estimated to be 83%.

To estimate cancer specific survival the authors censored patients known to be alive or who had died of other causes than prostate cancer. For overall survival the authors censored men known to be alive at the most recent follow-up.

These patients also underwent staging bilateral pelvic lymphadenectomy. It is not well stated in the article if their were patients who failed bilateral pelvic lymphadenectomy and were closed up without undergoing radical prostatectomy.

About half the men had stage T1(c) disease. Most were Gleason score 6 or 7, and the majority, 90%, underwent bilateral nerve sparing

217 men (6%) underwent adjuvant radiotherapy for adverse histopathological findings in their post-surgery specimens.

Failure Rates

631 of the 3,478 men (18%) have already experienced prostate cancer progression following their radical prostatectomy by William J. Catalona. The average (mean) time to recurrence of cancer was 38 months.

Of these 631 men who failed surgery, 68 (11%) had received posts-surgery radiation, and 39 went on to receive hormone blockade.

Actuarial 10-year biochemical progression-free survival probabilities by age group:
41 – 50 years old. 76%
51 - 60 years old. 71%
61 – 70 years old. 66%
> 70 years. 63%

The bottom line is that 32% of Dr. Catalona’s patients are expected to experience biochemical relapse of their prostate cancer at 10 years, defined as a PSA greater than 0.2 ng/ml. At an average follow-up of 5 years, 18% have already suffered a recurrence of their prostate cancer.

Dr. Catalona’s study comments on Dr. Patrick Walsh’s failure rates noting that Dr. Walsh had a projected 32 percent cancer reoccurrence rate at 10-years in 2,000 men reported on between 1982 and 1997, and that Dr. Walsh had a projected 34% biochemical relapse rate at 15 years when he updated his series to 2,404 men, even after excluding 90 men (3.7%) with adverse prognostic features from that analysis.

In my opinion, men deserve much better than undergoing major surgery only to suffer odds of cancer reoccurrence ranging from 32% to 37.7 percent.

Reference:

Roehl KA, Han M, Ramos CG, Antenor JA, Catalona WJ: Cancer progression and survival rates following anatomical radical retropubic prostatectomy in 3,478 consecutive patients: long-term results. J Urol. 2004 Sep;172(3):910-4.

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Copyright © 2005 Bradley R. Hennenfent, M.D.
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