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

Affiliations
  • 1Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. chung646@yuhs.ac
  • 2Department of Urology, Hallym University College of Medicine, Chuncheon, Korea.
  • 3Department of Urology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
  • 4Department of Urology, Inje University College of Medicine, Busan, Korea.
  • 5Department of Urology, Ajou University School of Medicine, Suwon, Korea.

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
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