MP70-18 MORTALITY IN MEN WITH ADVANCED PROSTATE CANCER MAY BE REDUCED WITH RADICAL TREATMENT COMPARED TO ANDROGEN DEPRIVATION ALONE

Abstract

You have accessJournal of UrologyProstate Cancer: Advanced II1 Apr 2014MP70-18 MORTALITY IN MEN WITH ADVANCED PROSTATE CANCER MAY BE REDUCED WITH RADICAL TREATMENT COMPARED TO ANDROGEN DEPRIVATION ALONE Prasanna Sooriakumaran, Tommy Nyberg, Olof Akre, Stefan Carlsson, Leif Haendler, Gunnar Steineck, and Peter Wiklund Prasanna SooriakumaranPrasanna Sooriakumaran More articles by this author , Tommy NybergTommy Nyberg More articles by this author , Olof AkreOlof Akre More articles by this author , Stefan CarlssonStefan Carlsson More articles by this author , Leif HaendlerLeif Haendler More articles by this author , Gunnar SteineckGunnar Steineck More articles by this author , and Peter WiklundPeter Wiklund More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2216AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Standard management for men with advanced prostate cancer is androgen deprivation therapy (ADT) alone. Our objective was to evaluate whether radical treatment of the primary tumor in men with advanced prostate cancer improved survival over those managed with ADT alone. METHODS The National Prostate Cancer Registry of Sweden is linked to eight national datasets to form PCBaSe and provides >98% complete information on virtually all patient and tumor covariates of all prostate cancer cases in Sweden diagnosed from 1996. We abstracted data from PCBaSe on men with PSA>50 or M+ or T4 disease, and matched them exactly for grade, T-stage, M-stage, and Charlson comorbidity index (CCI). We produced cumulative incidence curves (CICs) as well as performed statistical adjustments via classical regression techniques and propensity scoring, to compare prostate cancer mortality (PCM) and other cause mortality (OCM) in those men treated with ADT as primary therapy versus those treated initially with radical therapy (surgery or radiotherapy). RESULTS The matched sample was 699 cases per group. CICs demonstrated lower PCM (dark blue/orange) and OCM (light blue/orange) in the radical treatment group compared to the ADT group up to 14 years follow-up (Figure). Propensity score-adjusted subdistribution hazard ratios (sHR) for ADT versus radical treatment were 2.89 (95% CI, 2.25-3.71) for PCM and 1.41 (95% CI, 1.01-1.98) for OCM. A post-hoc sensitivity analysis found that a residual confounder differentially prevalent in 90% versus 10% in the ADT and radical treatment groups respectively would need a sHR of 4.09 to account for the above PCM point estimate, with still higher confounder sHR for less skewed confounder prevalences. CONCLUSIONS This large, observational study from a comprehensive dataset suggests that men with advanced prostate cancer might benefit in survival terms from being managed with radical therapy as their primary treatment rather than ADT alone. Confounding is highly unlikely to account for these results, and this study provides an epidemiologic rationale to consider a future RCT in this setting. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e812-e813 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Prasanna Sooriakumaran More articles by this author Tommy Nyberg More articles by this author Olof Akre More articles by this author Stefan Carlsson More articles by this author Leif Haendler More articles by this author Gunnar Steineck More articles by this author Peter Wiklund More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...