PD12-11 SURVIVAL BENEFIT OF RADICAL PROSTATECTOMY IN PATIENTS WITH CLINICALLY ADVANCED PROSTATE CANCER: ESTIMATIONS OF THE NUMBER NEEDED TO TREAT BASED ON COMPETING-RISKS ANALYSIS

Abstract

You have accessJournal of UrologyProstate Cancer: Localized I1 Apr 2014PD12-11 SURVIVAL BENEFIT OF RADICAL PROSTATECTOMY IN PATIENTS WITH CLINICALLY ADVANCED PROSTATE CANCER: ESTIMATIONS OF THE NUMBER NEEDED TO TREAT BASED ON COMPETING-RISKS ANALYSIS Giorgio Gandaglia, Maxine Sun, Jim Hu, Jonas Schiffmann, Andreas Becker, Ioana Popa, Nawar Hanna, Francesco Montorsi, Alberto Briganti, Quoc-Dien Trinh, Pierre I. Karakiewicz, and Firas Abdollah Giorgio GandagliaGiorgio Gandaglia More articles by this author , Maxine SunMaxine Sun More articles by this author , Jim HuJim Hu More articles by this author , Jonas SchiffmannJonas Schiffmann More articles by this author , Andreas BeckerAndreas Becker More articles by this author , Ioana PopaIoana Popa More articles by this author , Nawar HannaNawar Hanna More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author , Pierre I. KarakiewiczPierre I. Karakiewicz More articles by this author , and Firas AbdollahFiras Abdollah More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.983AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Radical prostatectomy (RP) and initial observation may be considered as therapeutic options for the management of patients with locally advanced prostate cancer (PCa). The aim of our study was to describe the survival benefit associated with RP, as compared to initial observation, in these patients. Specifically, we relied on competing-risks analyses to estimate cancer-specific mortality (CSM) rates of patients treated with RP and to compare them to patients treated with initial observation. METHODS Overall, 1,382 patients with locally advanced PCa (clinical stage T3/T4) treated with RP or initial observation between 1995 and 2009 within the Surveillance, Epidemiology, and End Results Medicare-linked were evaluated. Patients in both treatment arms (RP vs. observation) were matched using propensity-score methodology. Ten-year cancer-specific mortality (CSM) rates were estimated, and the number needed to treat (NNT) was calculated. Competing-risks regression analyses tested the relationship between treatment type and CSM. All analyses were repeated after stratifying patients according to Gleason score (≤7 vs. 8-10) and clinical stage (T3a vs. T3b/T4). RESULTS Overall, 908 (65.7%) and 474 (34.3%) patients were treated with observation and RP. Overall, the 10-year CSM rates were 11.8 vs. 19.3% for patients treated with RP vs. initial observation, respectively (P<0.001). The corresponding 10-year NNT was 13. The 10-year CSM rates for the same respective treatment groups were 8.9 vs. 13.9% for Gleason score ≤7, 16.8 vs. 27.8% for Gleason score 8-10, 10.1 vs. 15.8% for clinical stage T3a, and 17.0 vs. 29.3% for clinical stage T3b/T4, respectively (all P≤0.04). The corresponding NNTs were 20, 9, 17, and 8, respectively. In multivariable analyses, RP was an independent predictor of more favorable CSM in all categories (all P≤0.04). CONCLUSIONS Radical prostatectomy leads to a significant survival advantage compared to initial observation in patients with locally advanced disease. Particularly, 13 men with clinical stage T3/T4 should be treated with surgery to prevent one cancer-related death at 10-year follow-up. The highest survival benefit was observed in patients with more aggressive disease (i.e., clinical stage T3b/T4 and Gleason score 8-10 PCa). As such, surgery should be considered in these individuals when feasible. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e351 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Giorgio Gandaglia More articles by this author Maxine Sun More articles by this author Jim Hu More articles by this author Jonas Schiffmann More articles by this author Andreas Becker More articles by this author Ioana Popa More articles by this author Nawar Hanna More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Quoc-Dien Trinh More articles by this author Pierre I. Karakiewicz More articles by this author Firas Abdollah More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...