Cancer Res Treat.  2018 Jan;50(1):129-137. 10.4143/crt.2017.004.

Cancer-Specific Mortality Among Korean Men with Localized or Locally Advanced Prostate Cancer Treated with Radical Prostatectomy Versus Radiotherapy: A Multi-Center Study Using Propensity Scoring and Competing Risk Regression Analyses

• Koo KC
• Cho JS
• Bang WJ
• Lee SH
• Cho SY
• Kim SI
• Kim SJ
• Rha KH
• Hong SJ
• Chung BH

• KMID: 2403482
• DOI: http://doi.org/10.4143/crt.2017.004

Abstract

PURPOSE
Studies comparing radical prostatectomy (RP) outcomes with those of radiotherapy with or without androgen deprivation therapy (RT±ADT) for prostate cancer (PCa) have yielded conflicting results. Therefore, we used propensity score-matched analysis and competing risk regression analysis to compare cancer-specific mortality (CSM) and other-cause mortality (OCM) between these two treatments.
MATERIALS AND METHODS
The multi-center, Severance Urological Oncology Group registry was utilized to identify 3,028 patients with clinically localized or locally advanced PCa treated by RP (n=2,521) or RT±ADT (n=507) between 2000 and 2016. RT±ADT cases (n=339) were matched with an equal number of RP cases by propensity scoring based on age, preoperative prostate-specific antigen, clinical tumor stage, biopsy Gleason score, and Charlson Comorbidity Index (CCI). CSM and OCM were co-primary endpoints.
RESULTS
Median follow-up was 65.0 months. Five-year overall survival rates for patients treated with RP and RT±ADT were 94.7% and 92.0%, respectively (p=0.105). Cumulative incidence estimates revealed comparable CSM rates following both treatments within all National Comprehensive Cancer Network risk groups. Gleason score ≥ 8 was associated with higher risk of CSM (p=0.009). OCM rates were comparable between both groups in the low- and intermediate-risk categories (p=0.354 and p=0.643, respectively). For high-risk patients, RT±ADT resulted in higher OCM rates than RP (p=0.011). Predictors of OCM were age ≥ 75 years (p=0.002) and CCI ≥ 2 (p < 0.001).
CONCLUSION
RP and RT±ADT provide comparable CSM outcomes in patients with localized or locally advanced PCa. The risk of OCM may be higher for older high-risk patients with significant comorbidities.

Keyword

Prostatic neoplasms; Prostatectomy; Radiotherapy; Treatment outcome

MeSH Terms

Biopsy
Comorbidity
Follow-Up Studies
Humans
Incidence
Male
Mortality*
Neoplasm Grading
Passive Cutaneous Anaphylaxis
Prostate*
Prostate-Specific Antigen
Prostatectomy*
Prostatic Neoplasms*
Radiotherapy*
Regression Analysis*
Survival Rate
Treatment Outcome
Prostate-Specific Antigen

Reference

References

1. Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T, et al. EAU guidelines on prostate cancer. part 1: screening, diagnosis, and local treatment with curative intent-update 2013. Eur Urol. 2014; 65:124–37.

2. Mohler JL, Armstrong AJ, Bahnson RR, D'Amico AV, Davis BJ, Eastham JA, et al. NCCN clinical practice guidelines in oncology: prostate cancer, version 3 [Internet]. Fort Washington, PA: National Comprehensive Cancer Network;2016. [cited 2016 Mar 10]. Available from: http://www.jnccn.org/content/8/2/162.full.pdf+html.

3. Paulson DF, Lin GH, Hinshaw W, Stephani S. Radical surgery versus radiotherapy for adenocarcinoma of the prostate. J Urol. 1982; 128:502–4.

4. Wallace K, Fleshner N, Jewett M, Basiuk J, Crook J. Impact of a multi-disciplinary patient education session on accrual to a difficult clinical trial: the Toronto experience with the surgical prostatectomy versus interstitial radiation intervention trial. J Clin Oncol. 2006; 24:4158–62.

5. Merglen A, Schmidlin F, Fioretta G, Verkooijen HM, Rapiti E, Zanetti R, et al. Short- and long-term mortality with localized prostate cancer. Arch Intern Med. 2007; 167:1944–50.

6. Zelefsky MJ, Eastham JA, Cronin AM, Fuks Z, Zhang Z, Yamada Y, et al. Metastasis after radical prostatectomy or external beam radiotherapy for patients with clinically localized prostate cancer: a comparison of clinical cohorts adjusted for case mix. J Clin Oncol. 2010; 28:1508–13.

7. Albertsen PC, Hanley JA, Penson DF, Barrows G, Fine J. 13-year outcomes following treatment for clinically localized prostate cancer in a population based cohort. J Urol. 2007; 177:932–6.

8. Nepple KG, Stephenson AJ, Kallogjeri D, Michalski J, Grubb RL 3rd, Strope SA, et al. Mortality after prostate cancer treatment with radical prostatectomy, external-beam radiation therapy, or brachytherapy in men without comorbidity. Eur Urol. 2013; 64:372–8.

9. Kibel AS, Ciezki JP, Klein EA, Reddy CA, Lubahn JD, Haslag-Minoff J, et al. Survival among men with clinically localized prostate cancer treated with radical prostatectomy or radiation therapy in the prostate specific antigen era. J Urol. 2012; 187:1259–65.

10. Sooriakumaran P, Nyberg T, Akre O, Haendler L, Heus I, Olsson M, et al. Comparative effectiveness of radical prostatectomy and radiotherapy in prostate cancer: observational study of mortality outcomes. BMJ. 2014; 348:g1502.

11. Concato J, Shah N, Horwitz RI. Randomized, controlled trials, observational studies, and the hierarchy of research designs. N Engl J Med. 2000; 342:1887–92.

12. Donovan JL, Lane JA, Peters TJ, Brindle L, Salter E, Gillatt D, et al. Development of a complex intervention improved randomization and informed consent in a randomized controlled trial. J Clin Epidemiol. 2009; 62:29–36.

13. Cooperberg MR, Vickers AJ, Broering JM, Carroll PR. Comparative risk-adjusted mortality outcomes after primary surgery, radiotherapy, or androgen-deprivation therapy for localized prostate cancer. Cancer. 2010; 116:5226–34.

14. Penson DF. An update on randomized clinical trials in localized and locoregional prostate cancer. Urol Oncol. 2005; 23:280–8.

15. Rubin DB. On principles for modeling propensity scores in medical research. Pharmacoepidemiol Drug Saf. 2004; 13:855–7.

16. Boehmer D, Maingon P, Poortmans P, Baron MH, Miralbell R, Remouchamps V, et al. Guidelines for primary radiotherapy of patients with prostate cancer. Radiother Oncol. 2006; 79:259–69.

17. Akakura K, Suzuki H, Ichikawa T, Fujimoto H, Maeda O, Usami M, et al. A randomized trial comparing radical prostatectomy plus endocrine therapy versus external beam radiotherapy plus endocrine therapy for locally advanced prostate cancer: results at median follow-up of 102 months. Jpn J Clin Oncol. 2006; 36:789–93.

18. Johnston TJ, Shaw GL, Lamb AD, Parashar D, Greenberg D, Xiong T, et al. Mortality among men with advanced prostate cancer excluded from the ProtecT Trial. Eur Urol. 2017; 71:381–8.

19. Tewari A, Divine G, Chang P, Shemtov MM, Milowsky M, Nanus D, et al. Long-term survival in men with high grade prostate cancer: a comparison between conservative treatment, radiation therapy and radical prostatectomy: a propensity scoring approach. J Urol. 2007; 177:911–5.

20. Lee BH, Kibel AS, Ciezki JP, Klein EA, Reddy CA, Yu C, et al. Are biochemical recurrence outcomes similar after radical prostatectomy and radiation therapy? Analysis of prostate cancer-specific mortality by nomogram-predicted risks of biochemical recurrence. Eur Urol. 2015; 67:204–9.

21. Roach M 3rd, Ceron Lizarraga TL, Lazar AA. Radical prostatectomy versus radiation and androgen deprivation therapy for clinically localized prostate cancer: how good is the evidence? Int J Radiat Oncol Biol Phys. 2015; 93:1064–70.

22. Cooperberg MR, Grossfeld GD, Lubeck DP, Carroll PR. National practice patterns and time trends in androgen ablation for localized prostate cancer. J Natl Cancer Inst. 2003; 95:981–9.

23. Stephenson AJ, Kattan MW, Eastham JA, Dotan ZA, Bianco FJ Jr, Lilja H, et al. Defining biochemical recurrence of prostate cancer after radical prostatectomy: a proposal for a standardized definition. J Clin Oncol. 2006; 24:3973–8.

24. D’Amico AV, Denham JW, Crook J, Chen MH, Goldhaber SZ, Lamb DS, et al. Influence of androgen suppression therapy for prostate cancer on the frequency and timing of fatal myocardial infarctions. J Clin Oncol. 2007; 25:2420–5.

25. Keating NL, O’Malley AJ, Freedland SJ, Smith MR. Diabetes and cardiovascular disease during androgen deprivation therapy: observational study of veterans with prostate cancer. J Natl Cancer Inst. 2010; 102:39–46.

26. Nguyen PL, Je Y, Schutz FA, Hoffman KE, Hu JC, Parekh A, et al. Association of androgen deprivation therapy with cardiovascular death in patients with prostate cancer: a meta-analysis of randomized trials. JAMA. 2011; 306:2359–66.

27. Efstathiou JA, Bae K, Shipley WU, Hanks GE, Pilepich MV, Sandler HM, et al. Cardiovascular mortality and duration of androgen deprivation for locally advanced prostate cancer: analysis of RTOG 92-02. Eur Urol. 2008; 54:816–23.

28. Moon DH, Efstathiou JA, Chen RC. What is the best way to radiate the prostate in 2016? Urol Oncol. 2017; 35:59–68.

29. Wilt TJ, MacDonald R, Rutks I, Shamliyan TA, Taylor BC, Kane RL. Systematic review: comparative effectiveness and harms of treatments for clinically localized prostate cancer. Ann Intern Med. 2008; 148:435–48.

30. Zietman AL, DeSilvio ML, Slater JD, Rossi CJ Jr, Miller DW, Adams JA, et al. Comparison of conventional-dose vs high-dose conformal radiation therapy in clinically localized adenocarcinoma of the prostate: a randomized controlled trial. JAMA. 2005; 294:1233–9.