Journal article
Impact of treatment modality on overall survival in localized ductal prostate adenocarcinoma: A national cancer database analysis
Urologic oncology, Vol.39(6), pp.366.e11-366.e18
06/2021
DOI: 10.1016/j.urolonc.2020.11.013
PMID: 33223370
Abstract
•Surgery most common initial treatment in localized ductal prostate adenocarcinoma.•Surgery associated with favorable survival in nonmetastatic ductal prostate cancer.•Radiotherapy, systemic therapy and observation associated with worse outcomes.•PSA is a poor predictor of survival in localized ductal prostate adenocarcinoma.
Ductal adenocarcinoma is considered a rare histological variant of prostate adenocarcinoma (PCa). Given the rarity of this subtype, optimal treatment strategies for men with nonmetastatic ductal PCa is largely unknown. We aimed to describe the impact of surgery, radiotherapy, systemic therapy, and observation on overall survival (OS) in men with nonmetastatic ductal PCa.
We selected 1,656 cases of nonmetastatic ductal PCa, diagnosed between 2004 and 2015, within the National Cancer Database. Covariates included age, race, Charlson comorbidity score, clinical T stage, clinical lymph node stage, serum prostate specific antigen (PSA), income, hospital type, insurance status, year of diagnosis, and location of residence. Cox regression analysis tested the impact of treatment (surgery, radiotherapy, systemic therapy, and observation) on OS.
In men with nonmetastatic ductal PCa, median (interquartile range [IQR]) age and PSA were 67 (60–73) years and 6.2 (4.2–10.7) ng/ml, respectively. Advanced local stage (≥cT3a) was most frequently observed in patients initially treated with systemic therapy (34.8%), followed by those treated with radiotherapy (18.1%), surgery (7.1%) and observation (6.4%, P< 0.001). Serum PSA at presentation was highest in the systemic therapy cohort (median 16.0 ng/ml, IQR: 4.9–37.7), followed by the radiotherapy cohort (median 7.2 ng/ml, IQR: 4.1–12.2), observation cohort (median 7.0 ng/ml, IQR: 4.3–13.3) and surgery cohort (median 5.9 ng/ml, IQR: 4.3–9.2, P< 0.001). Multivariable analysis showed that in comparison to men treated surgically, OS was significantly lower for patients receiving radiotherapy (HR 2.2; 95% CI: 1.5–3.2), under observation (HR 4.6; 95% CI: 2.8–7.6) and receiving systemic therapy (HR 5.2; 95% CI: 3.0–9.1) as an initial course of treatment.
While limited by its retrospective nature, our study shows that starting treatment with surgery is associated with more favorable long-term OS outcomes than radiotherapy, systemic therapy or observation.
Details
- Title: Subtitle
- Impact of treatment modality on overall survival in localized ductal prostate adenocarcinoma: A national cancer database analysis
- Creators
- Chandler Bronkema - Henry Ford HospitalSohrab Arora - Henry Ford HospitalJacob Keeley - Henry Ford HospitalNikola Rakic - Henry Ford HospitalAkshay Sood - Henry Ford HospitalDeepansh Dalela - Henry Ford HospitalMarcus Jamil - Henry Ford HospitalJames O. Peabody - Henry Ford HospitalCraig G. Rogers - Henry Ford HospitalMani Menon - Henry Ford HospitalFiras Abdollah - Henry Ford Hospital
- Resource Type
- Journal article
- Publication Details
- Urologic oncology, Vol.39(6), pp.366.e11-366.e18
- DOI
- 10.1016/j.urolonc.2020.11.013
- PMID
- 33223370
- NLM abbreviation
- Urol Oncol
- ISSN
- 1078-1439
- eISSN
- 1873-2496
- Publisher
- Elsevier Inc
- Language
- English
- Date published
- 06/2021
- Academic Unit
- Urology
- Record Identifier
- 9984949472902771
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