Radical prostatectomy outcomes in a prostate cancer patient cohort managed by Public Hospitals in Auckland from 2006-2013

Abstract

Abstract Background- The current assessment defined the status of clinical and histopathology parameters of a patient cohort managed by radical prostatectomy (RP) at public hospitals in Auckland including their subsequent salvage management strategies, mortality, and survival outcomes.

Methods- Clinical and post-RP histology records of 134 PC patients managed with RP in Auckland public hospitals were retrospectively reviewed and recorded. Mortality data were accessed up to 2018 from the Ministry of Health databases. Parameters were assessed with and without stratification based on ethnicity.

Results- Overall, 9.0% and 56.7% recorded over- and under-diagnoses, respectively based on criteria from Pelzer et al 2008. Māori men recorded the highest under-diagnosis rate of 71%. The proportion of cases with extra-prostatic extension, seminal vesicle invasion (SVI), perineural invasion, positive surgical margins and lymph node invasion was 43%, 15.9%, 66.2%, 49.2% and 3%, respectively and are compared against other global recordings. Subsequent treatment requirements were the highest (71%) for men recording SVI and this group also recorded the highest combined treatment (33%) of radiation therapy and androgen deprivation therapy. All-cause mortality was highest among Māori cases 28.6% followed by Pacific (20%) and Europeans (16.2%) men. Prostate cancer-specific mortality (PCSM) was highest among Pacific (20%) followed by European (4.3%) men while Māori men recording 0% occurrences. Five-year survival rates were 100%, 100% and 96.6% for Māori, Pacific, and European men respectively. Median survival duration since diagnosis ranged from 7.6y (5.7, 10.7), 8.6y (7.8, 10.8) and 8.3y (7.1, 10.8) among Māori, Pacific, and European men respectively.

Conclusions- Higher under-diagnosis rates including in Māori cases compared to other developed countries is a concern. Māori men have shown a better benefit by RP towards PCSM although they still lead the overall mortality and the lowest survival since RP. This study was limited by a small sample size restricted to the Auckland region.