TY - JOUR
T1 - Survival Outcomes of Radical Prostatectomy Versus Radiotherapy in Intermediate-Risk Prostate Cancer
T2 - A NCDB Study
AU - Marsh, Sydney
AU - Walters, Ryan W.
AU - Silberstein, Peter T.
N1 - Funding Information:
The data used in this study are derived from a deidentified NCDB file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology used, or the conclusions drawn from these data by the investigators.
PY - 2018/2
Y1 - 2018/2
N2 - We used the National Cancer Data Base to evaluate survival in intermediate-risk prostate cancer. We included 268,378 men for survival and multivariable analyses. Men undergoing radical prostatectomy had the highest survival compared to men receiving radiotherapy or hormone therapy and no treatment. This leads us to support surgery as a first-line treatment in men with intermediate-risk prostate cancer. Background: Studies of various prostate cancer patient cohorts found men receiving external-beam radiotherapy (EBRT) had higher mortality than men undergoing radical prostatectomy (RP). Conversely, a recent clinical trial showed no survival differences between treatment groups. We used the National Cancer Data Base (NCDB) to evaluate overall survival in intermediate-risk (T2b-T2c or Gleason 7 [grade group II or III] or prostate-specific antigen 10-20 ng/mL) prostate cancer patients undergoing EBRT with or without androgen deprivation therapy (ADT), RP, or no initial treatment. Patients and Methods: We analyzed 268,378 men with intermediate-risk prostate cancer from 2004 to 2012. Kaplan-Meier estimates and multivariable Cox proportional hazards models were used to compare survival between treatments. Results: After adjusting for patient and facility covariables, men receiving no initial treatment averaged greater adjusted mortality risk than men receiving EBRT (hazard ratio [HR], 1.71; 95% confidence interval [CI] 1.62-1.80; P <.001), EBRT + ADT (HR, 1.73; 95% CI 1.64-1.81; P <.001), or RP (HR, 4.18; 95% CI 3.94-4.43; P <.001). Men undergoing RP had significantly lower adjusted mortality risk than men receiving either EBRT (HR, 0.41; 95% CI 0.39-0.43; P <.001) or EBRT + ADT (HR, 0.41; 95% CI 0.39-0.43; P <.001). No difference was observed between men receiving EBRT or EBRT + ADT (HR, 1.01; 95% CI 0.97-1.05; P =.624). Conclusion: Men treated with RP experienced significantly lower overall mortality risk than EBRT with or without ADT and no treatment patients, regardless of patient, demographic, or facility characteristics. The results are limited by the lack of cancer-specific mortality in this database.
AB - We used the National Cancer Data Base to evaluate survival in intermediate-risk prostate cancer. We included 268,378 men for survival and multivariable analyses. Men undergoing radical prostatectomy had the highest survival compared to men receiving radiotherapy or hormone therapy and no treatment. This leads us to support surgery as a first-line treatment in men with intermediate-risk prostate cancer. Background: Studies of various prostate cancer patient cohorts found men receiving external-beam radiotherapy (EBRT) had higher mortality than men undergoing radical prostatectomy (RP). Conversely, a recent clinical trial showed no survival differences between treatment groups. We used the National Cancer Data Base (NCDB) to evaluate overall survival in intermediate-risk (T2b-T2c or Gleason 7 [grade group II or III] or prostate-specific antigen 10-20 ng/mL) prostate cancer patients undergoing EBRT with or without androgen deprivation therapy (ADT), RP, or no initial treatment. Patients and Methods: We analyzed 268,378 men with intermediate-risk prostate cancer from 2004 to 2012. Kaplan-Meier estimates and multivariable Cox proportional hazards models were used to compare survival between treatments. Results: After adjusting for patient and facility covariables, men receiving no initial treatment averaged greater adjusted mortality risk than men receiving EBRT (hazard ratio [HR], 1.71; 95% confidence interval [CI] 1.62-1.80; P <.001), EBRT + ADT (HR, 1.73; 95% CI 1.64-1.81; P <.001), or RP (HR, 4.18; 95% CI 3.94-4.43; P <.001). Men undergoing RP had significantly lower adjusted mortality risk than men receiving either EBRT (HR, 0.41; 95% CI 0.39-0.43; P <.001) or EBRT + ADT (HR, 0.41; 95% CI 0.39-0.43; P <.001). No difference was observed between men receiving EBRT or EBRT + ADT (HR, 1.01; 95% CI 0.97-1.05; P =.624). Conclusion: Men treated with RP experienced significantly lower overall mortality risk than EBRT with or without ADT and no treatment patients, regardless of patient, demographic, or facility characteristics. The results are limited by the lack of cancer-specific mortality in this database.
UR - http://www.scopus.com/inward/record.url?scp=85028321112&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85028321112&partnerID=8YFLogxK
U2 - 10.1016/j.clgc.2017.07.029
DO - 10.1016/j.clgc.2017.07.029
M3 - Article
AN - SCOPUS:85028321112
VL - 16
SP - e39-e46
JO - Clinical Genitourinary Cancer
JF - Clinical Genitourinary Cancer
SN - 1558-7673
IS - 1
ER -