OBJECTIVE: To characterize population-based practice patterns, disease-specific and overall mortality, and cost associated with salvage cryotherapy (SCT) vs salvage radical prostatectomy (SRP).
METHODS: We retrospectively identified 440 men who failed primary radiation therapy and subsequently underwent SCT (n = 341, 77.5%) or SRP (n = 99, 22.5%) between 1992 and 2009 from Surveillance, Epidemiology, and End Results-Medicare linked data. Propensity score analyses were used to compare overall and prostate cancer-specific mortality and associated Medicare expenditures for SRP vs SCT.
RESULTS: Men undergoing SCT were more likely to be white (P < .001), less likely to be high school graduates (P = .008), and experienced shorter median time from diagnosis to salvage therapy (44.1 vs 60.1, P < .001) and from primary radiotherapy to salvage therapy (38.7 vs 55.8 months, P < .001). In adjusted analyses, overall mortality was higher (21.6 vs 6.1 deaths/100 person years, P < .001) for SRP vs SCT. There was a trend for higher prostate cancer-specific death rates with SRP vs SCT (6.5 vs 1.4 deaths/100 person years, P = .061). Medicare expenditures for SRP vs SCT were more than 2-fold higher ($19,543 vs $8,088, P < .001).
CONCLUSION: SRP vs SCT is associated with higher overall mortality and greater health care expenditures. However, longer follow-up is needed to assess long-term functional outcomes and cancer control.
Written by:
Friedlander DF, Gu X, Prasad SM, Lipsitz SR, Nguyen PL, Trinh QD, Sun M, Hu JC. Are you the author?
Division of Urology, Brigham and Women's Hospital, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA; Department of Urology, Medical University of South Carolina, Charleston, SC; Section of Urology, Ralph A. Johnson VA Medical Center, Charleston, SC; Department of Radiation Oncology, Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute, Boston, MA; Division of Urologic Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA; Department of Public Health, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada; Department of Urology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA.
Reference: Urology. 2014 Mar;83(3):653-7.
doi: 10.1016/j.urology.2013.11.019
PubMed Abstract
PMID: 24581527
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