A Competing Risk Analysis of Cancer-Specific Mortality of Initial Treatment with Radical Prostatectomy versus Radiation Therapy in Clinically Localized High-Risk Prostate Cancer

Lee, Joo Yong; Kwon, Jong Kyou; Jeh, Seong Uk; Kang, Ho Won; Diaz, Richilda Red; Ham, Won Sik; Koom, Woong Sub; Keum, Ki Chang; Choi, Young Deuk

doi:10.1245/s10434-014-3780-9

Cited by 30 publications

(23 citation statements)

References 34 publications

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“…A recent study by Lee et al included patients with high-risk localized PCa that was treated with RP ( N = 251) or RT plus neoadjuvant ADT (nADT) ( N = 125)25. Results showed that the 5-yr CSS was longer in patients treated with RP compared with the combined group (96.5% vs. 88.3%).…”

Section: Resultsmentioning

confidence: 99%

Systematic Review and Meta-analysis of the Survival Outcomes of First-line Treatment Options in High-risk Prostate Cancer

Lei

Liu

Wang

et al. 2015

Sci Rep

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Prostate cancer (PCa) is the most common non-dermatologic cancer in the western countries in western countries. High-risk PCa accounts for 15% of the diagnosed cases. In this study, we compare the long-term survival outcomes of radical prostatectomy (RP), radiation therapy (RT), brachytherapy (BT), androgen- deprivation therapy (ADT), and watchful waiting (WW) in high-risk prostate cancer (PCa). Overall, RP/(RT plus ADT) gave the best survival outcome in patients with high-risk PCa, whereas ADT/WW had the worst outcome. The overall priority for treatment strategy could be ranked as follows: RP/(RT plus ADT), RT, and ADT/WW. RP had significant better overall survival (OS) than RT or BT, and RP had significant lower cancer-specific mortality (CSM) than RT (0.51 [95% CI 0.30–0.73], P<0.001). ADT improved the cancer-specific survival (CSS) of RP based on a case-controlled study; added ADT to RT failed to challenge the position of RP but could improve the outcome of RT. In conclusions,RP/(RT plus adjuvant ADT) could both be used for the first-line therapy of high-risk PCa. When encountering an individual patient, urologists should consider various factors like tumors themselves, preferences of individuals, and so on.

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Section: Resultsmentioning

confidence: 99%

Systematic Review and Meta-analysis of the Survival Outcomes of First-line Treatment Options in High-risk Prostate Cancer

Lei

Liu

Wang

et al. 2015

Sci Rep

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“…21 However, this finding was based on two small retrospective studies and the authors of the meta-analysis were concerned about the limited quality of most studies included in the meta-analysis. 22,23 In contrast, Boorjian et al reported similar 10-year cancer-specific survival in patients treated with RP or RT + ADT. 8 Overall, the retrospective data that compared outcomes of RP to RT + ADT suffered from selection bias, variable length of ADT use, and contamination of the RP cohort by adjuvant and salvage therapies.…”

Section: Discussionmentioning

confidence: 98%

“…[4][5][6][7] On the other hand, large retrospective studies with long followup times demonstrated equivalence of RP to RT + ADT. [8][9][10][21][22][23][24][25][26] A meta-analysis showed a modest improvement in cancer-specific survival with RP compared to RT + ADT. 21 However, this finding was based on two small retrospective studies and the authors of the meta-analysis were concerned about the limited quality of most studies included in the meta-analysis.…”

Section: Discussionmentioning

confidence: 99%

An audit of referral and treatment patterns of high-risk prostate cancer patients in Alberta

Alghamdi

Taggar

Tilley

et al. 2016

CUAJ

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Introduction: We aimed to determine the impact of clinical practice guidelines (CPG) on rates of radiation oncologist (RO) referral, androgen-deprivation therapy (ADT), radiation therapy (RT), and radical prostatectomy (RP) in patients with high-risk prostate cancer (HR-PCa). Methods: All men >18 years, diagnosed with PCa in 2005 and 2012 were identified from the Alberta Cancer Registry. Patient age, aggregated clinical risk group (ACRG) score, Gleason score (GS), pre-treatment prostate-specific antigen (PSA), RO referral, and treatment received were extracted from electronic medical records. Logistic regression modelling was used to examine associations between RO referral rates and relevant factors. Results: HR-PCa was diagnosed in 261 of 1792 patients in 2005 and 435 of 2148 in 2012. Median age and ACRG scores were similar in both years (p>0.05). The rate of patients with PSA >20 were 67% and 57% in 2005 and 2012, respectively (p=0.004). GS ≤6 was found in 13% vs. 5% of patients, GS 7 in 27% vs. 24%, and GS ≥8 in 59% vs. 71% in 2005 and 2012, respectively (p<0.001). In 2005, RO referral rate was 68% compared to 56% in 2012 (p=0.001), use of RT + ADT was 53% compared to 32% (p<0.001), and RP rate was 9% vs. 17% (p=0.002). On regression analysis, older age, 2012 year of diagnosis and higher PSA were associated with decreased RO referral rates (odds ratios [OR] 0.49, 95% confidence interval [CI] 0.39-0.61; OR 0.51, 95% CI 0.34-0.76; and OR 0.64, 95% CI 0.39-0.61), respectively [p<0.001]). Conclusions: Since CPG creation in 2005, RO referral rates and ADT + RT use declined and RP rates increased, which demonstrates a need to improve adherence to CPG in the HR-PCa population.

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“…Due to insufficient power and small series (89 patients) no conclusion could be drawn about the efficacy. Nonetheless, some observational data suggest that outcomes with RP lead to better overall and cancer-specific survival than RT [108–112]. Wallis and colleagues recently published a meta-analysis comparing RP with EBRT or BT [108].…”

Section: Rt Compared To Surgerymentioning

confidence: 99%

Prostate Cancer Radiation Therapy: What Do Clinicians Have to Know?

Vanneste

Limbergen

Lin

et al. 2016

BioMed Research International

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Radiotherapy (RT) for prostate cancer (PC) has steadily evolved over the last decades, with improving biochemical disease-free survival. Recently population based research also revealed an association between overall survival and doses ≥ 75.6 Gray (Gy) in men with intermediate- and high-risk PC. Examples of improved RT techniques are image-guided RT, intensity-modulated RT, volumetric modulated arc therapy, and stereotactic ablative body RT, which could facilitate further dose escalation. Brachytherapy is an internal form of RT that also developed substantially. New devices such as rectum spacers and balloons have been developed to spare rectal structures. Newer techniques like protons and carbon ions have the intrinsic characteristics maximising the dose on the tumour while minimising the effect on the surrounding healthy tissue, but clinical data are needed for confirmation in randomised phase III trials. Furthermore, it provides an overview of an important discussion issue in PC treatment between urologists and radiation oncologists: the comparison between radical prostatectomy and RT. Current literature reveals that all possible treatment modalities have the same cure rate, but a different toxicity pattern. We recommend proposing the possible different treatment modalities with their own advantages and side-effects to the individual patient. Clinicians and patients should make treatment decisions together (shared decision-making) while using patient decision aids.

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A Competing Risk Analysis of Cancer-Specific Mortality of Initial Treatment with Radical Prostatectomy versus Radiation Therapy in Clinically Localized High-Risk Prostate Cancer

Abstract: Initial treatment with RP versus RT was associated with a decreased risk of CSM in men with clinically localized high-risk PC.

Cited by 30 publications

References 34 publications

Systematic Review and Meta-analysis of the Survival Outcomes of First-line Treatment Options in High-risk Prostate Cancer

Systematic Review and Meta-analysis of the Survival Outcomes of First-line Treatment Options in High-risk Prostate Cancer

An audit of referral and treatment patterns of high-risk prostate cancer patients in Alberta

Prostate Cancer Radiation Therapy: What Do Clinicians Have to Know?

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