Mortality After Radical Prostatectomy or External Beam Radiotherapy for Localized Prostate Cancer

Richard M Hoffman; Tatsuki Koyama; David F Penson; Kang-Hsien Fan; Peter C Albertsen; Michael J Barry; Michael Goodman; Ann S Hamilton; Arnold L Potosky; Janet L Stanford; Antoinette M Stroup

doi:10.1093/jnci/djt059

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Mortality After Radical Prostatectomy or External Beam Radiotherapy for Localized Prostate Cancer

Journal article

Open access

Peer reviewed

Mortality After Radical Prostatectomy or External Beam Radiotherapy for Localized Prostate Cancer

Richard M Hoffman, Tatsuki Koyama, David F Penson, Kang-Hsien Fan, Peter C Albertsen, Michael J Barry, Michael Goodman, Ann S Hamilton, Arnold L Potosky, Janet L Stanford, …

JNCI : Journal of the National Cancer Institute, Vol.105(10), pp.711-718

2013

DOI: 10.1093/jnci/djt059

PMCID: PMC3653822

PMID: 23615689

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Abstract

Background: No randomized trials have compared survival outcomes for men with localized prostate cancer (PC) being treated with radical prostatectomy (RP) or external beam radiotherapy (EBRT). The goal of the study, therefore, was to estimate the association of RP (compared with EBRT) with overall and PC mortality. Methods: We analyzed an observational cohort from the population-based Prostate Cancer Outcomes Study, which included men aged 55 to 74 years diagnosed with localized PC between October 1994 and October 1995 who underwent either RP (n = 1164) or EBRT (n = 491) within 1 year of diagnosis. Patients were followed until death or study end (December 31, 2010). Overall and disease-specific mortality were assessed with multivariable survival analysis, with propensity scores to adjust for potential treatment selection confounders (demographics, comorbidities, and tumor characteristics). All statistical tests were two-sided. Results: After 15 years of follow-up, there were 568 deaths, including 104 from PC. RP was associated with statistically significant advantages for overall (hazard ratio [HR] = 0.60, 95% confidence interval [CI] = 0.53 to 0.70, P <.0001.) and disease-specific mortality (HR = 0.35, 95% CI = 0.26 to 0.49, P <.0001.). Mortality benefits for RP were also observed within treatment propensity quintiles, when subjects were pair-matched on propensity scores, and in subgroup analyses based on age, tumor characteristics, and comorbidity. Conclusions: Population-based observational data on men diagnosed with localized PC in the mid-1990s suggest a mortality benefit associated with RP vs EBRT. Possible explanations include residual selection bias or a true survival advantage. Results might be less applicable for men facing treatment decisions today.

Tumors

Biological and medical sciences

Medical sciences

Multiple tumors. Solid tumors. Tumors in childhood (general aspects)

Nephrology. Urinary tract diseases

Tumors of the urinary system

Urinary tract. Prostate gland

Details

Title: Subtitle: Mortality After Radical Prostatectomy or External Beam Radiotherapy for Localized Prostate Cancer
Creators: Richard M Hoffman - University of Iowa, Internal Medicine
Tatsuki Koyama - Department of Biostatistics and the Center for Quantitative Sciences, Vanderbilt University, Nashville, TN, United States
David F Penson - VA Tennessee Valley Geriatric Research, Education, and Clinical Center, Nashville, TN, United States
Kang-Hsien Fan - Department of Urologic Surgery and the Center for Surgical Quality and Outcomes Research, Vanderbilt University, Nashville, TN, United States
Peter C Albertsen - Division of Urology, Department of Surgery, University of Connecticut School of Medicine, Farmington, CT, United States
Michael J Barry - General Medicine Division, Massachusetts General Hospital, Boston, MA, United States
Michael Goodman - Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
Ann S Hamilton - Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
Arnold L Potosky - Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, United States
Janet L Stanford - Fred Hutchinson Cancer Research Center, Seattle, WA, United States
Antoinette M Stroup - University of Utah, Salt Lake City, UT, United States
Resource Type: Journal article
Publication Details: JNCI : Journal of the National Cancer Institute, Vol.105(10), pp.711-718
DOI: 10.1093/jnci/djt059
PMID: 23615689
PMCID: PMC3653822
NLM abbreviation: J Natl Cancer Inst
ISSN: 0027-8874
eISSN: 1460-2105
Publisher: Oxford University Press
Language: English
Date published: 2013
Academic Unit: Epidemiology; General Internal Medicine; Internal Medicine
Record Identifier: 9984203346002771

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