Articles

A Competing-Risks Analysis of Survival After Alternative Treatment Modalities for Prostate Cancer Patients: 1988–2006

By: Firas Abdollaha b lowast , Maxine Suna, Rodolphe Thureta b c, Claudio Jeldresa b c d e, Zhe Tiana, Alberto Brigantib, Shahrokh F. Shariatd, Paul Perrottea b c d e, Patrizio Rigattib, Francesco Montorsib and Pierre I. Karakiewicza b c d e

Published online: 01 January 2011

Keywords: Observation, Prostatic neoplasms/mortality, Prostatic neoplasms/therapy, Radiotherapy/statistics and numerical data, SEER Program, United States/epidemiology

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Abstract

Background

The efficacy of prostate cancer (PCa) treatment modalities is a subject of continuous debate.

Objective

We tested the hypothesis that significant differences in survival rates may exist among PCa patients treated with radical prostatectomy (RP), radiation therapy (RT), and observation.

Design, setting, and participants

We focused on 404 604 patients with clinically localized PCa within 17 Surveillance, Epidemiology and End Results registries.

Measurements

Competing-risks survival analyses were used to estimate cancer-specific mortality (CSM) and other-cause mortality (OCM) rates. Patients were stratified according to treatment type, age group, and PCa risk group (high risk: T2c and/or Gleason score 8–10; low to intermediate risk: all others).

Results and limitations

The 10-yr CSM and OCM rates were 6.1% and 29.2%, respectively. In RP, RT, and observation patients, CSM rates were 3.6%, 6.5%, and 10.8% (p<0.001), respectively; OCM rates were 17.1%, 32.4%, and 48.9% (p<0.001), respectively. In low- to intermediate-risk patients, the lowest CSM (1.3–3.7%) and OCM (6.9–31.6%) rates within all age categories except octogenarians (8.9% and 62.8%, respectively) were recorded in RP. In high-risk patients, the lowest CSM (5.8–7.2%) and OCM (8.7–16.1%) rates in patients aged≤69 yr were also recorded in RP. RT was equally favorable to RP in the 70–79 age category and appeared ideal in all octogenarian patients.

Conclusions

Our results showed that RP provides the most favorable survival rates in most patients. The exception is octogenarian men, in whom RT provides the best results. Finally, the least-favorable outcomes were recorded after observation. However, these findings must be interpreted within the context of the limitations of observational data.

Take Home Message

Radical prostatectomy provides the most favorable survival rates in most prostate cancer patients. The exception consists of octogenarian men, for whom radiation therapy provides best results. The least-favorable outcomes were recorded after observation.

Keywords: Observation, Prostatic neoplasms/mortality, Prostatic neoplasms/therapy, Radiotherapy/statistics and numerical data, SEER Program, United States/epidemiology.

Footnotes

a Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada

b Department of Urology, Vita Salute San Raffaele University, Milan, Italy

c Department of Urology, University of Montpellier Health Centre, Montpellier, France

d Department of Urology, Weill Medical College of Cornell University, New York, USA

e Department of Urology, University of Montreal Health Centre, Montreal, Canada

lowast Corresponding author. Cancer Prognostics and Health Outcome Unit, University of Montreal Health Center (CHUM), 1058, rue St-Denis, Montreal, Quebec, Canada, H2X 3J4. Tel. +1 514 890 8000 35336; Fax: +1 514 227 5103.