Risk of Death From Prostate Cancer After Radical Prostatectomy or Brachytherapy in Men With Low or Intermediate Risk Disease
Abstract
Purpose:
Radical prostatectomy and brachytherapy are widely used treatments for favorable risk prostate cancer. We estimated the risk of prostate cancer specific mortality following radical prostatectomy or brachytherapy in men with low or intermediate risk prostate cancer using prospectively collected data.
Materials and Methods:
The study cohort comprised 5,760 men with low risk prostate cancer (prostate specific antigen 10 ng/ml or less, clinical category T1c or 2a and Gleason score 6 or less), and 3,079 with intermediate risk prostate cancer (prostate specific antigen 10 to 20 ng/ml, clinical category T2b or T2c, or Gleason score 7). Competing risks multivariable regression was performed to assess the risk of prostate cancer specific mortality after radical prostatectomy or brachytherapy, adjusting for age, year of treatment, cardiovascular comorbidity and known prostate cancer prognostic factors.
Results:
After a median followup of 4.2 years (IQR 2.0–7.4) for low risk and 4.8 years (IQR 2.2–8.1) for intermediate risk men, there was no significant difference in the risk of prostate cancer specific mortality among low risk (adjusted hazard ratio 1.62, 95% CI 0.59–4.45, p = 0.35) or intermediate risk men (AHR 2.30, 95% CI 0.95–5.58, p = 0.07) treated with brachytherapy compared with radical prostatectomy. The only factor associated with an increased risk of prostate cancer specific mortality (AHR 1.05, 95% CI 1.01–1.10, p = 0.03) was increasing age at treatment in intermediate risk men.
Conclusions:
The risk of prostate cancer specific mortality in men with low or intermediate risk prostate cancer was not significantly different following radical prostatectomy vs brachytherapy.
References
- 1 : Time trends in clinical risk stratification for prostate cancer: implications for outcomes (data from CaPSURE). J Urol2003; 170: S21. Link, Google Scholar
- 2 : Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA1998; 280: 969. Google Scholar
- 3 : Multi-institutional analysis of long-term outcome for stages T1-T2 prostate cancer treated with permanent seed implantation. Int J Radiat Oncol Biol Phys2007; 67: 327. Google Scholar
- 4 : 15-Year biochemical relapse free survival in clinical stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy; Seattle experience. Int J Radiat Oncol Biol Phys2007; 67: 57. Google Scholar
- 5 : Long-term biochemical disease-free and cancer-specific survival following anatomic radical retropubic prostatectomy: The 15-year Johns Hopkins experience . Urol Clin North Am2001; 28: 555. Google Scholar
- 6 : Radical retropubic prostatectomy versus brachytherapy for low-risk prostatic cancer: a prospective study. World J Urol2009; 27: 607. Google Scholar
- 7 : Survival of men with clinically localized prostate cancer treated with prostatectomy, brachytherapy, or no definitive treatment: impact of age at diagnosis. Cancer2006; 107: 2392. Google Scholar
- 8 : Failure definition-dependent differences in outcome following radiation for localized prostate cancer: can one size fit all?. Int J Radiat Oncol Biol Phys2005; 61: 409. Google Scholar
- 9 :
Prostate . In: AJCC Cancer Staging Manual. Edited by . New York: Springer2002: 309. Google Scholar - 10 : High-risk prostate cancer in the United States, 1990–2007. World J Urol2008; 26: 211. Google Scholar
- 11 : Deaths: final data for 2007: National Vital Statistics Reports . Hyattsville: National Center for Health StatisticsMay 2010. Web release vol 58 no 19 http://www.cdc.gov/nchs/deaths.htm. Accessed August 24, 2010. Google Scholar
- 12 : Hormonal therapy use for prostate cancer and mortality in men with coronary artery disease-induced congestive heart failure or myocardial infarction. JAMA2009; 302: 866. Google Scholar
- 13 :
An Introduction to Categorical Data Analysis . In: . New York: John Wiley & Sons2002: 16. Google Scholar - 14 :
Nonparametric Statistical Methods . In: . New York: John Wiley & Sons1999: 189. Google Scholar - 15 : A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc1999; 94: 496. Google Scholar
- 16 : On the use of cause-specific failure and conditional failure probabilities: examples from clinical oncology data. J Am Stat Assoc1993; 88: 400. Google Scholar
- 17 : A class of K-sample tests for comparing the cumulative incidence of a competing risk. Ann Stat1988; 16: 1141. Google Scholar
- 18
Simultaneous inferences and other topics in regression analyses-1 . In: Applied Linear Regression Models. Edited by . Homewood, Illinois: R. D. Irwin1983: 150. Google Scholar - 19 : A contemporary study correlating prostate needle biopsy and radical prostatectomy Gleason score. J Urol2008; 179: 1335. Link, Google Scholar
- 20 : Adjuvant radiotherapy for pathological T3N0M0 prostate cancer significantly reduces risk of metastases and improves survival: long-term follow-up of a randomized clinical trial. J Urol2009; 181: 956. Link, Google Scholar
- 21 : Postoperative radiotherapy after radical prostatectomy: a randomised controlled trial (EORTC trial 22911). Lancet2005; 366: 572. Google Scholar
- 22 : Phase III postoperative adjuvant radiotherapy after radical prostatectomy compared with radical prostatectomy alone in pT3 prostate cancer with postoperative undetectable prostate-specific antigen: ARO 96-02/AUO AP 09/95. J Clin Oncol2009; 27: 2924. Google Scholar
- 23 : Does androgen suppression enhance the efficacy of postoperative irradiation?: A secondary analysis of RTOG 85-31. Radiation Therapy Oncology Group . Urology1999; 54: 495. Google Scholar
- 24 : Role of early adjuvant hormonal therapy after radical prostatectomy for prostate cancer. J Urol2001; 166: 2208. Link, Google Scholar
- 25 : Metastasis after radical prostatectomy or external beam radiotherapy for patients with clinically localized prostate cancer: a comparison of clinical cohorts adjusted for case mix. J Clin Oncol2010; 28: 1508. Google Scholar
- 26 : Biochemical outcomes after prostate brachytherapy with 5-year minimal follow-up: importance of patient selection and implant quality. Int J Radiat Oncol Biol Phys2003; 57: 645. Google Scholar
- 27 : Natural history of clinically staged low- and intermediate-risk prostate cancer treated with monotherapeutic permanent interstitial brachytherapy. Int J Radiat Oncol Biol Phys2010; 76: 349. Google Scholar
- 28 : Provider case volume and outcomes following prostate brachytherapy. J Urol2009; 181: 113. Link, Google Scholar
- 29 : Brachytherapy or surgery?: A composite view . Oncology (Williston Park)2009; 23: 960. Google Scholar
