Erratum: Comparative risk‐adjusted mortality outcomes after primary surgery, radiotherapy, or androgen‐deprivation therapy for localized prostate cancer

Abstract

NIH Public Access Author Manuscript Cancer. Author manuscript; available in PMC 2011 November 15. NIH-PA Author Manuscript Published in final edited form as: Cancer. 2010 November 15; 116(22): 5226–5234. doi:10.1002/cncr.25456. Comparative risk-adjusted mortality outcomes following primary surgery, radiation therapy, or androgen deprivation therapy for localized prostate cancer Matthew R. Cooperberg, MD, MPH (1),† , Andrew J. Vickers, PhD (2) , Jeanette M. Broering, RN, MS, MPH (1) , Peter R. Carroll, MD, MPH (1) , and the CaPSURE Investigators (1) Department of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA Department of Epidemiology and Biostatistics, Memorial-Sloan Kettering Cancer Center, New York, NY NIH-PA Author Manuscript Abstract Purpose—No adequate randomized trials comparing active treatment modalities for localized prostate cancer have been reported. We analyzed risk-adjusted cancer-specific mortality outcomes among men undergoing radical prostatectomy, external-beam radiation therapy, or primary androgen deprivation therapy. Methods—The CaPSURE registry comprises men from 40 urologic practice sites followed prospectively under uniform protocols, regardless of treatment. 7538 men with localized disease were analyzed. Prostate cancer risk was assessed using the Kattan preoperative nomogram and the Cancer of the Prostate Risk Assessment (CAPRA) score, both well-validated instruments calculated from clinical data at the time of diagnosis. A parametric survival model was constructed to compare outcomes across treatments, adjusting for risk and age. NIH-PA Author Manuscript Results—226 men died of prostate cancer during followup. Adjusting for age and risk, the hazard ratio for cancer-specific mortality relative to prostatectomy was 2.21 (1.50–3.24) for radiation, and 3.22 (2.16–4.81) for androgen deprivation. Absolute differences between prostatectomy and radiation therapy were small for men at low risk, but increased substantially for men at intermediate and high risk. These results were robust to a variety of different analytic techniques including competing risks regression analysis, adjustment by CAPRA rather than Kattan score, and examination of overall survival as the endpoint. Conclusions—Prostatectomy for localized prostate cancer was associated with a significant and substantial reduction in mortality relative to radiation or androgen deprivation monotherapy. Although not a randomized study, given the multiple adjustments and sensitivity analyses it is unlikely that unmeasured confounding would account for the large observed differences in survival. Keywords prostate neoplasms; comparative effectiveness; surgery; radiation; hormonal therapy; CaPSURE To whom correspondence should be addressed: University of California, San Francisco, Box 1695, 1600 Divisadero St, A-607, San Francisco, CA 94143-1695, tel (415) 885-3660, fax (415) 885-7443, mcooperberg@urology.ucsf.edu.