335 SURGERY VERSUS RADIOTHERAPY IN PROSTATE CANCER: ANALYSIS OF MORTALITY OUTCOMES IN 34,515 PATIENTS TREATED WITH UP TO 15 YEARS FOLLOW-UP

Abstract

You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History (II)1 Apr 2013335 SURGERY VERSUS RADIOTHERAPY IN PROSTATE CANCER: ANALYSIS OF MORTALITY OUTCOMES IN 34,515 PATIENTS TREATED WITH UP TO 15 YEARS FOLLOW-UP Prasanna Sooriakumaran, Leif Haendler, Tommy Nyberg, Inge Heus, Mats Olsson, Stefan Carlsson, Monique Roobol, and Peter Wiklund Prasanna SooriakumaranPrasanna Sooriakumaran Stockholm, Sweden More articles by this author , Leif HaendlerLeif Haendler Stockholm, Sweden More articles by this author , Tommy NybergTommy Nyberg Stockholm, Sweden More articles by this author , Inge HeusInge Heus Rotterdam, Netherlands More articles by this author , Mats OlssonMats Olsson Stockholm, Sweden More articles by this author , Stefan CarlssonStefan Carlsson Stockholm, Sweden More articles by this author , Monique RoobolMonique Roobol Stockholm, Sweden More articles by this author , and Peter WiklundPeter Wiklund Stockholm, Sweden More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1721AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There is a paucity of high quality data comparing the survival outcomes of surgery versus radiotherapy in the treatment of prostate cancer. This large observational study aimed to compare such outcomes in a Swedish cohort treated from 1996 onwards. METHODS 34,515 men were treated for prostate cancer throughout Sweden with either surgery (n=21,533) or radiotherapy (n=12,982) as their first treatment option and form the study cohort. Patients were categorized by risk group (localized- low risk, localized- intermediate risk, localized- high risk, and non-localized- any T3-4, N+, M+, PSA>50), age (<65, 65-74, ≥75), and CCI (0, 1, ≥2); cumulative incidence curves for prostate-cancer-mortality (PCM) and other-cause-mortality (OCM) were derived. Competing risks regression hazard ratios for radiotherapy versus surgery were computed without adjustment and with propensity score and classical (multivariable) adjustments using all relevant covariates. RESULTS PCM became a larger proportion of overall mortality as risk group increased for both the surgery and radiotherapy cohorts; for localized prostate cancer patients (risk groups 1-3) survival outcomes favored surgery, and for locally advanced/metastatic patients treatment results were similar (see Figure below: light blue/orange= OCM; dark blue/orange= PCM). The unadjusted and adjusted hazard ratios generally confirmed significant benefits for surgery over radiotherapy in PCM for low and intermediate risk disease, younger patients, and those with lower CCI. The only cohort in which radiotherapy had superior PCM outcomes was those aged 65-74 with non-localized disease. CONCLUSIONS This large observational study with follow-up up to 15 years demonstrates that surgery is superior to radiotherapy in terms of prostate cancer survival for the majority of men with localized prostate cancer. Radiotherapy is at least equivalent to surgery for men with non-localized disease. Age and co-morbidity also play a part in the comparative effectiveness of treatments for prostate cancer. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e135-e136 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Prasanna Sooriakumaran Stockholm, Sweden More articles by this author Leif Haendler Stockholm, Sweden More articles by this author Tommy Nyberg Stockholm, Sweden More articles by this author Inge Heus Rotterdam, Netherlands More articles by this author Mats Olsson Stockholm, Sweden More articles by this author Stefan Carlsson Stockholm, Sweden More articles by this author Monique Roobol Stockholm, Sweden More articles by this author Peter Wiklund Stockholm, Sweden More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...