Prostate Cancer Impact of Age and Comorbidities on Long-term Survival of Patients with High-risk Prostate Cancer Treated with Radical Prostatectomy: A Multi-institutional Competing-risks Analysis Alberto Briganti a, *, Martin Spahn b , Steven Joniau c , Paolo Gontero d , Marco Bianchi a , Burkhard Kneitz b , Felix K.H. Chun e , Maxine Sun f , Markus Graefen g , Firas Abdollah a , Giansilvio Marchioro h , Detlef Frohenberg i , Simone Giona d , Bruno Frea j , Pierre I. Karakiewicz f , Francesco Montorsi a , Hein Van Poppel c , R. Jeffrey Karnes k , on behalf of the European Multicenter Prostate Cancer Clinical and Translational Research Group (EMPaCT) a Department of Urology, Vita Salute University, San Raffaele Scientific Institute, Milan, Italy; b University Hospital Wu ¨rzburg, Department of Urology and Pediatric Urology, Wu ¨rzburg, Germany; c University Hospitals Leuven, Department of Urology, Leuven, Belgium; d University of Turin, Department of Urology, Turin, Italy; e University Hospital Hamburg-Eppendorf, Department of Urology, Hamburg, Germany; f Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; g Martiniclinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany; h University of Piemonte Orientale, Department of Urology, Novara, Italy; i Community Hospital Karlsruhe, Department of Urology, Karlsruhe, Germany; j Department of Urology, University of Udine, Udine, Italy; k Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, MN, USA EUROPEAN UROLOGY 63 (2013) 693–701 available at www.sciencedirect.com journal homepage: www.europeanurology.com Article info Article history: Accepted August 27, 2012 Published online ahead of print on September 4, 2012 Keywords: Prostate cancer Radical prostatectomy High risk Survival Comorbidity Mortality Competing risks Age Abstract Background: Survival after surgical treatment using competing-risk analysis has been previously examined in patients with prostate cancer (PCa). However, the combined effect of age and comorbidities has not been assessed in patients with high-risk PCa who might have heterogeneous rates of competing mortality despite the presence of aggres- sive disease. Objective: To examine the risk of 10-yr cancer-specific mortality (CSM) and other-cause mortality (OCM) according to clinical and pathologic characteristics of patients treated with radical prostatectomy (RP) for high-risk PCa. Design, setting, and participants: Within a multi-institutional cohort, 3828 men treated with RP for high-risk PCa (defined as the presence of at least one of these risk factors: prostate-specific antigen >20 ng/ml, biopsy Gleason score 8–10, clinical stage T3) were identified. Intervention: All patients underwent RP and pelvic lymph node dissection. Outcome measurements and statistical analysis: Competing-risk Poisson regression analyses were performed to simultaneously assess the 10-yr CSM and OCM rates after RP. The same analyses were also conducted after stratification of patients according to age at surgery, comorbidity status assessed by the Charlson Comorbidity Index (CCI), and number of risk factors (one vs two or more). Results and limitations: Overall, 229 patients (5.9%) died from PCa; 549 (14.3%) died from other causes. The 10-yr CSM and OCM rates ranged from 5.1% to 12.8% and from 4.3% to 37.4%, respectively. Age and CCI were the major determinants of OCM; their impact on CSM was minimal. OCM was the leading cause of death in all patient groups * Corresponding author. Department of Urology Vita Salute University - San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy. Tel. +39 02 26437286; Fax: +39 02 26437298. E-mail addresses: briganti_alberto@yahoo.it, briganti.alberto@hsr.it (A. Briganti). 0302-2838/$ – see back matter # 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.eururo.2012.08.054