Causes of death after radical prostatectomy at a large tertiary center

Purpose: Most men treated with radical prostatectomy do not die of prostate cancer. We evaluated the cause of death in a large series of patients who underwent radical prostatectomy and compared the rate of death to that of the general American population.

Materials and methods: The study population consisted of 18,209 men who underwent radical prostatectomy at our institution between 1975 and 2009. Close patient followup and a national database were used to identify which patients died and classify the cause of death. These data were compared with general American population data from the National Vital Statistics System.

Results: Median age at radical prostatectomy was 59 years (IQR 54.0-63.0). At a median followup of 7.4 years (IQR 3.7-11.9) 1,419 patients had died (7.8%), including 379 of prostate cancer. Actuarial 10 and 20-year overall survival rates after radical prostatectomy were 92.6% and 69.2%, respectively. The overall death rate was lower in men treated with radical prostatectomy than in the general American population (standardized mortality ratio 0.47, 95% CI 0.44-0.49). Differences were particularly pronounced for heart disease, chronic respiratory conditions, diabetes and infection. Of men who died of a nonprostate cancer cause 44.0% died of a secondary malignancy.

Conclusions: Overall survival after radical prostatectomy is excellent. Men who undergo radical prostatectomy usually die of a nonprostate cancer cause. Almost half of patients who survive prostate cancer die of a secondary malignancy, likely due to the selection of surgical candidates at low cardiopulmonary risk.