PD51-05 SURVIVAL ASSOCIATED WITH RADICAL PROSTATECTOMY VERSUS RADIOTHERAPY FOR HIGH-RISK PROSTATE CANCER: A CONTEMPORARY, NATIONWIDE OBSERVATIONAL ANALYSIS

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy VI1 Apr 2017PD51-05 SURVIVAL ASSOCIATED WITH RADICAL PROSTATECTOMY VERSUS RADIOTHERAPY FOR HIGH-RISK PROSTATE CANCER: A CONTEMPORARY, NATIONWIDE OBSERVATIONAL ANALYSIS Tarun Jindal, Deeoansh Dalela, Patrick Karabon, Malte Vetterlein, Thomas Seisen, Akshay Sood, Quoc-Dien Trinh, Wooju Jeong, Mani Menon, and Firas Abdollah Tarun JindalTarun Jindal More articles by this author , Deeoansh DalelaDeeoansh Dalela More articles by this author , Patrick KarabonPatrick Karabon More articles by this author , Malte VetterleinMalte Vetterlein More articles by this author , Thomas SeisenThomas Seisen More articles by this author , Akshay SoodAkshay Sood More articles by this author , Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author , Wooju JeongWooju Jeong More articles by this author , Mani MenonMani Menon More articles by this author , and Firas AbdollahFiras Abdollah More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2205AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The optimal primary treatment for men with clinically high-risk prostate cancer (PCa) is controversial as both radical prostatectomy (RP) and radiotherapy (RT) are associated with potential advantages and disadvantages. Our objective was to compare the overall mortality-free survival of high-risk PCa patients treated with primary RP vs. primary RT with neoadjuvant/adjuvant androgen deprivation therapy [ADT], within the National Cancer Data Base (NCDB). METHODS Within the NCDB, a total of 87,875 high-risk PCa patients fulfilled our pre-specified inclusion criteria (53,197 in RP group and 34,678 in RT+ADT group). We employed an instrumental variable analysis (IVA) approach using the yearly rate of RP as the instrument, to mitigate the impact of both observed and unobserved confounders. Multiple sensitivity analyses were performed, including stratification for age, comorbidity, ADT utilization and high dose (>75.6 Gy) RT. In addition, the overall mortality-free survival of RP was compared to that of RT reported in three recently published randomized controlled trails (RCTs), after selecting only RP patients who fitted inclusion/exclusion criteria of these RCTs. RESULTS On IVA adjusting for socio-demographic, facility- and tumor-specific covariates, RP was associated with lower overall mortality compared to RT+ADT (hazard ratio (HR) 0.52; 95% CI, 0.47-0.57; p<0.001) in the overall analysis, in patients with age =65 years with CCI 0 (HR 0.48; p<0.001), in patients >65 years with CCI 0 (0.53; p<0.001), those receiving RT with neoadjuvant (HR 0.52; p<0.001) or adjuvant ADT (HR 0.47; p<0.001), or treated with high dose (=75.6 Gy) RT (HR 0.54; p<0.001). While the survival outcomes for patients treated with RT (+/-ADT) in the RCTs were not statistically different from similarly treated and appropriately selected patients within the NCDB, RP was associated with greater overall mortality-free survival than any of the arms represented in the RCTs. CONCLUSIONS Our results suggest that in patients with clinically high-risk PCa, primary RP is associated with greater overall mortality-free survival than primary RT+ADT in patients with clinically high-risk PCa, regardless of baseline characteristics. These findings, in lieu of a randomized trial, can guide the clinicians to carefully choose the primary modality of treatment for patients with high-risk PCa. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e985-e986 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Tarun Jindal More articles by this author Deeoansh Dalela More articles by this author Patrick Karabon More articles by this author Malte Vetterlein More articles by this author Thomas Seisen More articles by this author Akshay Sood More articles by this author Quoc-Dien Trinh More articles by this author Wooju Jeong More articles by this author Mani Menon More articles by this author Firas Abdollah More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...