Radical prostatectomy vs radiotherapy vs observation among older patients with clinically localized prostate cancer: a comparative effectiveness evaluation. (13th August 2013)

• Record Type: Journal Article
• Authors: Sun, Maxine; Sammon, Jesse D.; Becker, Andreas; Roghmann, Florian; Tian, Zhe; Kim, Simon P.; Larouche, Alexandre; Abdollah, Firas; Hu, Jim C.; Karakiewicz, Pierre I.; Trinh, Quoc‐Dien
• Is Part Of: BJU international. Volume 113:Number 2(2014:Feb.)
• Page Start: 200
• Page End: 208
• Publication Date: 2013-08-13
• Subjects: Genitourinary organs -- Diseases -- Periodicals; Genitourinary organs -- Surgery -- Periodicals; Urology -- Periodicals; 616.6
• DOI: 10.1111/bju.12321
• Languages: English
• ISSNs: 1464-4096

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bju12321-sec-0001" sec-type="section"> <title>Objective</title> <p> <list id="bju12321-list-0001" list-type="bullet"> <list-item> <p>To compare efficacy between radical prostatectomy (RP), radiotherapy and observation with respect to overall survival (OS) in patients with clinically localized prostate cancer (PCa).</p> </list-item> </list> </p> </sec> <sec id="bju12321-sec-0002" sec-type="section"> <title>Methods</title> <p> <list id="bju12321-list-0002" list-type="bullet"> <list-item> <p>Using data (1988–2005) from the Surveillance, Epidemiology, and End Results–Medicare linked database, 67 087 men with localized PCa were identified.</p> </list-item> <list-item> <p>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.</p> </list-item> <list-item> <p>Stratified (by stage and LE) Cox regression and competing‐risks regression analyses were generated for the prediction of OS and cancer‐specific mortality, respectively.</p> </list-item> </list> </p> </sec> <sec id="bju12321-sec-0003" sec-type="section"> <title>Results</title> <p> <list id="bju12321-list-0003" list-type="bullet"> <list-item> <p>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%).</p> </list-item> <list-item> <p>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, <italic>P</italic> = 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, <italic>P</italic> < 0.001) and radiotherapy (HR: 0.66, 95% CI: 0.56–0.79, <italic>P</italic> < 0.001).</p> </list-item> <list-item> <p>Similar results were recorded in competing‐risks regression analyses.</p> </list-item> </list> </p> </sec> <sec id="bju12321-sec-0004" sec-type="section"> <title>Conclusion</title> <p> <list id="bju12321-list-0004" list-type="bullet"> <list-item> <p>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.</p> </list-item> </list> </p> </sec> </abstract>