OBJECTIVE: To describe the survival benefit associated with radical prostatectomy (RP), as compared to initial observation, in patients with locally advanced prostate cancer (PCa).
PATIENTS AND METHODS: Overall, 1,382 patients with locally advanced PCa treated with RP or initial observation between 1995 and 2009 within the Surveillance, Epidemiology, and End Results (SEER)-Medicare were identified. Patients 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.
RESULTS: Overall, the 10-year CSM rates were 11.8 vs. 19.3% for patients treated with RP vs. 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 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). In separate sensitivity analyses, no differences were recorded when patients treated with radiotherapy were compared with those receiving RP (P=0.4). Conversely, patients undergoing initial observation had higher risk of CSM compared to those treated with radiotherapy (P=0.03).
CONCLUSIONS: RP leads to a significant survival advantage compared to observation in patients with locally advanced disease. The highest benefit was observed in patients with T3b/T4 and Gleason score 8-10 disease.
Written by:
Gandaglia G1, Sun M, Trinh QD, Becker A, Schiffmann J, Hu JC, Briganti A, Montorsi F, Perrotte P, Karakiewicz PI, Abdollah F. Are you the author?
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Department of Urology, Urological Research Institute, Vita Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy.
Reference: BJU Int. 2014 Jan 27. Epub ahead of print.
doi: 10.1111/bju.12645
PubMed Abstract
PMID: 24467651
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