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Local Therapy Improves Survival in Metastatic Prostate Cancer

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Local Therapy Improves Survival in Metastatic Prostate Cancer. / Leyh-Bannurah, Sami-Ramzi; Gazdovich, Stéphanie; Budäus, Lars; Zaffuto, Emanuele; Briganti, Alberto; Abdollah, Firas; Montorsi, Francesco; Schiffmann, Jonas; Menon, Mani; Shariat, Shahrokh F; Fisch, Margit; Chun, Felix; Steuber, Thomas; Huland, Hartwig; Graefen, Markus; Karakiewicz, Pierre I.

In: EUR UROL, Vol. 72, No. 1, 07.2017, p. 118-124.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Leyh-Bannurah, S-R, Gazdovich, S, Budäus, L, Zaffuto, E, Briganti, A, Abdollah, F, Montorsi, F, Schiffmann, J, Menon, M, Shariat, SF, Fisch, M, Chun, F, Steuber, T, Huland, H, Graefen, M & Karakiewicz, PI 2017, 'Local Therapy Improves Survival in Metastatic Prostate Cancer', EUR UROL, vol. 72, no. 1, pp. 118-124. https://doi.org/10.1016/j.eururo.2017.03.020

APA

Leyh-Bannurah, S-R., Gazdovich, S., Budäus, L., Zaffuto, E., Briganti, A., Abdollah, F., Montorsi, F., Schiffmann, J., Menon, M., Shariat, S. F., Fisch, M., Chun, F., Steuber, T., Huland, H., Graefen, M., & Karakiewicz, P. I. (2017). Local Therapy Improves Survival in Metastatic Prostate Cancer. EUR UROL, 72(1), 118-124. https://doi.org/10.1016/j.eururo.2017.03.020

Vancouver

Leyh-Bannurah S-R, Gazdovich S, Budäus L, Zaffuto E, Briganti A, Abdollah F et al. Local Therapy Improves Survival in Metastatic Prostate Cancer. EUR UROL. 2017 Jul;72(1):118-124. https://doi.org/10.1016/j.eururo.2017.03.020

Bibtex

@article{47070b04ebb14b02973182fae5f8bdc5,
title = "Local Therapy Improves Survival in Metastatic Prostate Cancer",
abstract = "BACKGROUND: Treatment of the primary, termed local therapy (LT), may improve survival in metastatic prostate cancer (mPCa) versus no local therapy (NLT).OBJECTIVE: To assess cancer-specific mortality (CSM) after LT versus NLT in mPCa.DESIGN, SETTING, AND PARTICIPANTS: Within the Surveillance, Epidemiology and End Results database (2004-2013), 13 692 mPCa patients were treated with LT (radical prostatectomy [RP] or radiation therapy [RT]) or NLT.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Multivariable competing risk regression analyses (MVA CRR) tested CSM after propensity score matching (PSM) in two analyses, (1) NLT versus LT and (2) RP versus RT, and were complemented with interaction, sensitivity, unmeasured confounder, and landmark analyses.RESULTS AND LIMITATIONS: Of 13 692 mPCa patients, 474 received LT: 313 underwent RP and 161 RT. In MVA CRR, after PSM, LT (n=474) results in lower CSM (subhazard ratio [SHR] 0.40, 95% confidence interval [CI] 0.32-0.50) versus NLT (n=1896). In MVA CRR after PSM, RP (n=161) results in lower CSM (SHR 0.59, 95% CI 0.35-0.99) versus RT (n=161). Invariably, lowest CSM rates were recorded for Gleason ≤7, ≤cT3, and M1a substage. Interaction and sensitivity analyses confirmed the robustness of results, and landmark analyses rejected the bias favouring LT. A strong unmeasured confounder (HR=5), affecting 30% of NLT patients, could obliterate LT benefit. Data were retrospective.CONCLUSIONS: In mPCa, LT results in lower mortality relative to NLT. Within LT, lower mortality is recorded after RP than RT. Patients with most favourable grade, local stage, and metastatic substage derive most benefit from LT. They also derive most benefit from RP, when LT types are compared (RP vs RT). It is important to consider study limitations until ongoing clinical trials confirm the proposed benefits.PATIENT SUMMARY: Individuals with prostate cancer that spreads outside of the prostate might still benefit from prostate-directed treatments, such as radiation or surgery, in addition to receiving androgen deprivation therapy.",
keywords = "Journal Article",
author = "Sami-Ramzi Leyh-Bannurah and St{\'e}phanie Gazdovich and Lars Bud{\"a}us and Emanuele Zaffuto and Alberto Briganti and Firas Abdollah and Francesco Montorsi and Jonas Schiffmann and Mani Menon and Shariat, {Shahrokh F} and Margit Fisch and Felix Chun and Thomas Steuber and Hartwig Huland and Markus Graefen and Karakiewicz, {Pierre I}",
note = "Copyright {\textcopyright} 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.",
year = "2017",
month = jul,
doi = "10.1016/j.eururo.2017.03.020",
language = "English",
volume = "72",
pages = "118--124",
journal = "EUR UROL",
issn = "0302-2838",
publisher = "Elsevier",
number = "1",

}

RIS

TY - JOUR

T1 - Local Therapy Improves Survival in Metastatic Prostate Cancer

AU - Leyh-Bannurah, Sami-Ramzi

AU - Gazdovich, Stéphanie

AU - Budäus, Lars

AU - Zaffuto, Emanuele

AU - Briganti, Alberto

AU - Abdollah, Firas

AU - Montorsi, Francesco

AU - Schiffmann, Jonas

AU - Menon, Mani

AU - Shariat, Shahrokh F

AU - Fisch, Margit

AU - Chun, Felix

AU - Steuber, Thomas

AU - Huland, Hartwig

AU - Graefen, Markus

AU - Karakiewicz, Pierre I

N1 - Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.

PY - 2017/7

Y1 - 2017/7

N2 - BACKGROUND: Treatment of the primary, termed local therapy (LT), may improve survival in metastatic prostate cancer (mPCa) versus no local therapy (NLT).OBJECTIVE: To assess cancer-specific mortality (CSM) after LT versus NLT in mPCa.DESIGN, SETTING, AND PARTICIPANTS: Within the Surveillance, Epidemiology and End Results database (2004-2013), 13 692 mPCa patients were treated with LT (radical prostatectomy [RP] or radiation therapy [RT]) or NLT.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Multivariable competing risk regression analyses (MVA CRR) tested CSM after propensity score matching (PSM) in two analyses, (1) NLT versus LT and (2) RP versus RT, and were complemented with interaction, sensitivity, unmeasured confounder, and landmark analyses.RESULTS AND LIMITATIONS: Of 13 692 mPCa patients, 474 received LT: 313 underwent RP and 161 RT. In MVA CRR, after PSM, LT (n=474) results in lower CSM (subhazard ratio [SHR] 0.40, 95% confidence interval [CI] 0.32-0.50) versus NLT (n=1896). In MVA CRR after PSM, RP (n=161) results in lower CSM (SHR 0.59, 95% CI 0.35-0.99) versus RT (n=161). Invariably, lowest CSM rates were recorded for Gleason ≤7, ≤cT3, and M1a substage. Interaction and sensitivity analyses confirmed the robustness of results, and landmark analyses rejected the bias favouring LT. A strong unmeasured confounder (HR=5), affecting 30% of NLT patients, could obliterate LT benefit. Data were retrospective.CONCLUSIONS: In mPCa, LT results in lower mortality relative to NLT. Within LT, lower mortality is recorded after RP than RT. Patients with most favourable grade, local stage, and metastatic substage derive most benefit from LT. They also derive most benefit from RP, when LT types are compared (RP vs RT). It is important to consider study limitations until ongoing clinical trials confirm the proposed benefits.PATIENT SUMMARY: Individuals with prostate cancer that spreads outside of the prostate might still benefit from prostate-directed treatments, such as radiation or surgery, in addition to receiving androgen deprivation therapy.

AB - BACKGROUND: Treatment of the primary, termed local therapy (LT), may improve survival in metastatic prostate cancer (mPCa) versus no local therapy (NLT).OBJECTIVE: To assess cancer-specific mortality (CSM) after LT versus NLT in mPCa.DESIGN, SETTING, AND PARTICIPANTS: Within the Surveillance, Epidemiology and End Results database (2004-2013), 13 692 mPCa patients were treated with LT (radical prostatectomy [RP] or radiation therapy [RT]) or NLT.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Multivariable competing risk regression analyses (MVA CRR) tested CSM after propensity score matching (PSM) in two analyses, (1) NLT versus LT and (2) RP versus RT, and were complemented with interaction, sensitivity, unmeasured confounder, and landmark analyses.RESULTS AND LIMITATIONS: Of 13 692 mPCa patients, 474 received LT: 313 underwent RP and 161 RT. In MVA CRR, after PSM, LT (n=474) results in lower CSM (subhazard ratio [SHR] 0.40, 95% confidence interval [CI] 0.32-0.50) versus NLT (n=1896). In MVA CRR after PSM, RP (n=161) results in lower CSM (SHR 0.59, 95% CI 0.35-0.99) versus RT (n=161). Invariably, lowest CSM rates were recorded for Gleason ≤7, ≤cT3, and M1a substage. Interaction and sensitivity analyses confirmed the robustness of results, and landmark analyses rejected the bias favouring LT. A strong unmeasured confounder (HR=5), affecting 30% of NLT patients, could obliterate LT benefit. Data were retrospective.CONCLUSIONS: In mPCa, LT results in lower mortality relative to NLT. Within LT, lower mortality is recorded after RP than RT. Patients with most favourable grade, local stage, and metastatic substage derive most benefit from LT. They also derive most benefit from RP, when LT types are compared (RP vs RT). It is important to consider study limitations until ongoing clinical trials confirm the proposed benefits.PATIENT SUMMARY: Individuals with prostate cancer that spreads outside of the prostate might still benefit from prostate-directed treatments, such as radiation or surgery, in addition to receiving androgen deprivation therapy.

KW - Journal Article

U2 - 10.1016/j.eururo.2017.03.020

DO - 10.1016/j.eururo.2017.03.020

M3 - SCORING: Journal article

C2 - 28385454

VL - 72

SP - 118

EP - 124

JO - EUR UROL

JF - EUR UROL

SN - 0302-2838

IS - 1

ER -