Radical prostatectomy vs radiotherapy vs observation among older patients with clinically localized prostate cancer: A comparative effectiveness evaluation

Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.
BJU International (Impact Factor: 3.53). 06/2013; 113(2). DOI: 10.1111/bju.12321
Source: PubMed


To compare efficacy between radical prostatectomy (RP), radiotherapy and observation with respect to overall survival (OS) in patients with clinically localized prostate cancer (PCa).
Using data (1988-2005) from the Surveillance, Epidemiology, and End Results-Medicare linked database, 67 087 men with localized PCa were identified. The prevalence of the initial treatment strategy was quantified according to patients' life expectancy ([LE] <10 vs ≥10 years) at initial diagnosis and according to tumour stage. To reduce the unmeasured bias associated with treatment, we performed an instrumental variable analysis. Stratified (by stage and LE) Cox regression and competing-risks regression analyses were generated for the prediction of OS and cancer-specific mortality, respectively.
Among patients with <10 years of LE, most were treated with radiotherapy (49%) or observation (47%). Among patients with ≥10 years of LE, most received radiotherapy (49%), followed by RP (26%). In men with <10 years of LE, RP and radiotherapy were not different with respect to OS (hazard ratio [HR]: 0.81, 95% confidence interval [CI]: 0.45-1.48, P = 0.499). Conversely, in men with ≥10 years of LE, RP was associated with an improved OS compared with observation (HR: 0.59, 95% CI: 0.49-0.71, P < 0.001) and radiotherapy (HR: 0.66, 95% CI: 0.56-0.79, P < 0.001). Similar results were recorded in competing-risks regression analyses.
In patients with an estimated LE ≥10 years at initial diagnosis, RP was associated with improved survival compared with radiotherapy and observation, regardless of disease stage.

13 Reads

  • BJU International 02/2014; 113(2):179-80. DOI:10.1111/bju.12393 · 3.53 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To identify appropriate risk stratification system for intermediate-risk prostate cancer (PCa). Classifying patients according to National Comprehensive Cancer Network (NCCN) risk groups, we reviewed data of 1559 radical prostatectomy (RP) patients who were treated at our institution from 2005 to 2013. For our analyses, intermediate-risk PCa meeting at least one of two following factors were designated as unfavorable intermediate-risk disease: biopsy Gleason score 4 + 3 and/or multiple (≥ 2) intermediate-risk criteria present. All other men with intermediate-risk PCa were designated as having favorable intermediate-risk disease. Postoperative outcomes including biochemical recurrence (BCR)-free survivals were calculated and compared via log-rank test and Cox proportional hazards model. In multivariable analysis, biopsy Gleason score 4 + 3 and multiple (≥ 2) intermediate-risk criteria were observed to be independent predictors of the risk of BCR amongst intermediate-risk group undergoing RP. Favorable intermediate-risk group showed a significantly higher 5-year BCR-free survival than unfavorable group (87.5% vs 66.5%) (p < 0.001). Unfavorable intermediate-risk group showed significantly higher 5-year BCR-free survival than high-risk group (66.5% vs. 47.9%) (p < 0.001) while favorable intermediate-risk group demonstrated significantly lower 5-year BCR-free survival than low-risk group (87.5% vs. 93.5%) (p = 0.002). A significant heterogeneity exists in biochemical outcomes of contemporary patients with intermediate-risk PCa who underwent definitive RP. According to biopsy Gleason score and number of intermediate-risk criteria present, intermediate-risk group should be stratified into favorable and unfavorable disease.
    BJU International 02/2014; 115(6). DOI:10.1111/bju.12703 · 3.53 Impact Factor

  • BMJ (online) 03/2014; 348:g2273. DOI:10.1136/bmj.g2273 · 17.45 Impact Factor
Show more

Similar Publications