Prostate cancer-specific survival differences in patients treated by radical prostatectomy versus curative radiotherapy

Abstract

E299Cite as: Can Urol Assoc J 2013;7(5-6):e299-305. http://dx.doi.org/10.5489/cuaj.11294 Published online May 13, 2013 (early released July 16, 2012). AbstractObjective: We compared the cause-specific survival of patients who received radiotherapy to those who received surgery for cure of their prostate cancer using a number of design and analytic steps to mitigate confounding by indication. Methods: This was a case-cohort study of 2213 patients in the Ontario Cancer Registry diagnosed between 1990 and 1998 who were either treatment candidates or received curative radiotherapy or surgery. Cases included patients who died of prostate cancer within 10 years. The study population was restricted to those who were candidates for either treatment (radiotherapy or surgery) based on disease severity (low and intermediate risk using the Genitourinary Radiation Oncologists of Canada risk groups). The median follow-up was 51 months. Cause-specific survival was analyzed using Cox-proportional hazards regression with casecohort variance adjustment. Results from intent-to-treat analyses were compared to results by treatment received. Results: Adjusted hazard ratios for risk of prostate cancer death for radiotherapy compared to surgery for the entire study population were 1.62 (95%CI 1.00-2.61) and 2.02 (1.19-3.43) analyzing by intent-to-treat and treatment received, respectively. Intent-to-treat hazard ratios for the low-and intermediate-risk groups were 0.87 (0.28-2.76) and 1.57 (0.95-2.61), respectively. Conclusion: Overall results were driven by the finding in the intermediate-risk group, which indicated that radiotherapy was not as effective as surgery in this group. Confirmation was needed with special attention paid to risk stratification and the impact of more contemporary delivery of these treatment options.

Age remains the major predictor of curative treatment non-receipt for localised prostate cancer: a population-based study

“…Few randomised clinical trials have compared outcomes between radical prostatectomy and radiotherapy. One trial suggested that, for low/intermediate-risk tumours, radiotherapy and radical prostatectomy offer similar biochemical disease-free survival, but that radiotherapy is more effective than surgery for those with high-risk disease (Aizer et al , 2009) findings corroborated by a population-based study (DeGroot et al , 2012). Two other population-based studies have suggested that patients with high-risk disease and without comorbidity benefit more from surgery than radiotherapy (Ladjevardi et al , 2010; Abdollah et al , 2012a).…”

‘What is this active surveillance thing?’ Men's and partners' reactions to treatment decision making for prostate cancer when active surveillance is the recommended treatment option

“…In 2014, the NCCN guidelines were amended, removing the option of AS for those with intermediate risk PC . Up to 12‐year survival rates are similar for men with LPC randomised to either observation or RP , and RP and radiotherapy survival outcomes are also similar . Despite this, estimated AS uptake rates for men with LPC are 10% and 42% in American and Australian men, respectively.…”

Can patients with low‐risk prostate cancer really benefit from radical treatment?: A systematic review and network meta‐analysis

“…After removing the duplicates, we identified 2,334 records from the initial title and abstract screening process, retrieved and reviewed 74 articles in full‐text assessment for eligibility, among which 52 were excluded based on the following reasons: no original articles ( n = 4), not population of interest ( n = 7), 100 or fewer participants ( n = 6), no outcome of interest ( n = 22), insufficient data ( n = 6), studies focused only on high‐risk or intermediate‐risk prostate cancer ( n = 7). Finally, 22 RCTs and retrospective articles (Abdollah et al., 2012; Aizer et al., 2009; Albertsen et al., 2007; Arvold et al., 2011; Bill‐Axelson et al., 2014; Colberg et al., 2007; Degroot et al., 2013; Fosså et al., 2014; Giberti et al., 2009; Hamdy et al., 2016; Hayashi et al., 2019; Hoffman et al., 2013; Ladjevardi et al., 2010; Merglen et al., 2007; Merino et al., 2013; Patrick & Walsh, 2005; Resnick et al., 2013; Rice et al., 2013; Stattin et al., 2010; Taguchi et al., 2015; Tward et al., 2010; Wong et al., 2006) were included in our NMA with a total of 185,363 patients treated by at least one of the three treatment strategies. Sixteen trials (Aizer et al., 2009; Albertsen et al., 2007; Arvold et al., 2011; Degroot et al., 2013; Fosså et al., 2014; Giberti et al., 2009; Hamdy et al., 2016; Hayashi et al., 2019; Ladjevardi et al., 2010; Merglen et al., 2007; Merino et al., 2013; Patrick & Walsh, 2005; Resnick et al., 2013; Rice et al., 2013; Stattin et al., 2010; Taguchi et al., 2015) investigated RP versus RT, whereas 11 trials (Abdollah et al., 2012; Albertsen et al., 2007; Bill‐Axelson et al., 2014; Fosså et al., 2014; Hamdy et al., 2016; Ladjevardi et al., 2010; Merglen et al., 2007; Stattin et al., 2010; ...…”