PD43-01 LONG-TERM COMPARATIVE MORTALITY OUTCOMES ACROSS DIFFERENT PRIMARY TREATMENTS FOR PROSTATE CANCER

Abstract

INTRODUCTION AND OBJECTIVES: Randomized trials comparing different active treatments for localized prostate cancer have not been completed, although a number of studies in recent years have reported comparative outcomes using a variety of data sources, generally focusing of surgery and external-beam radiation. We analyzed extended followup in a large, community-based disease registry, comparing cancer-specific mortality across all major treatment alternatives. METHODS: Data were abstracted from CaPSURE, a prostate cancer registry which has been collecting data on men managed at a total of 47 clinical sites, primarily community-based, across the U.S. since 1995. Primary treatment was determined, and cancer-specific mortality (CSM) was assessed using a Weibull regression model adjusting for age and risk as summarized by the CAPRA score or the Kattan preoperative nomogram. RESULTS: Of 9912 men with known treatment and complete risk stratification data, 426 (4.3%) died of prostate cancer, at a median 86 months after diagnosis. Median followup for censored men was 61 months. Figure 1 illustrates unadjusted Kaplan-Meier plots by treatment, with mortality rates rising sharply beyond 12 years followup. The results of the adjusted analysis are shown in Figure 2, which indicates likelihood of 15-year CSM by primary treatment over a range of risk scores. CSM was unlikely for low-risk disease regardless of treatment, but for higher risk disease substantial differences were seen, favoring local treatment in general and radical prostatectomy in particular. Brachytherapy and external-beam radiation yielded similar results. Primary hormonal therapy results were similar to those seen for active surveillance. CONCLUSIONS: These results support a management paradigm including active surveillance for most men with low risk disease and aggressive multimodal treatment including surgery for men with high-risk prostate cancer. Source of Funding: None