Radical prostatectomy improves survival in selected metastatic prostate cancer patients: A North American population-based study
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Radical prostatectomy improves survival in selected metastatic prostate cancer patients: A North American population-based study. / Stolzenbach, Lara Franziska; Deuker, Marina; Collà-Ruvolo, Claudia; Nocera, Luigi; Tian, Zhe; Maurer, Tobias; Steuber, Thomas; Tilki, Derya; Briganti, Alberto; Saad, Fred; Chun, Felix Kh; Graefen, Markus; Karakiewicz, Pierre I.
In: INT J UROL, Vol. 28, No. 8, 08.2021, p. 834-839.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Radical prostatectomy improves survival in selected metastatic prostate cancer patients: A North American population-based study
AU - Stolzenbach, Lara Franziska
AU - Deuker, Marina
AU - Collà-Ruvolo, Claudia
AU - Nocera, Luigi
AU - Tian, Zhe
AU - Maurer, Tobias
AU - Steuber, Thomas
AU - Tilki, Derya
AU - Briganti, Alberto
AU - Saad, Fred
AU - Chun, Felix Kh
AU - Graefen, Markus
AU - Karakiewicz, Pierre I
N1 - © 2021 The Authors. International Journal of Urology published by John Wiley & Sons Australia, Ltd on behalf of the Japanese Urological Association.
PY - 2021/8
Y1 - 2021/8
N2 - OBJECTIVE: To test whether radical prostatectomy might result in better survival than external beam radiation therapy in metastatic prostate cancer patients.METHODS: Newly diagnosed metastatic prostate cancer patients with M1a/b substages, treated with radical prostatectomy or external beam radiation therapy were abstracted from the Surveillance, Epidemiology and End Results database (2004-2016). Temporal trend analyses, propensity score matching, cumulative incidence plots, multivariate competing risks regression models and landmark analyses were used.RESULTS: Of 4280 patients, 954 (22.3%) were treated with radical prostatectomy. After propensity score matching, 5-year cancer-specific mortality was 47.0 versus 53.0% in radical prostatectomy versus external beam radiation therapy patients (P = 0.003). In propensity score matched competing risks regression models, radical prostatectomy was associated with lower cancer-specific mortality versus external beam radiation therapy (hazard ratio 0.79, 95% confidence interval 0.79-0.90; P = 0.001). Finally, landmark analyses rejected the bias favoring radical prostatectomy. Finally, in subgroup analyses, we relied on selection criteria that most closely resembled the STAMPEDE criteria and a similar hazard ratio of 0.8 (P < 0.001) was recorded.CONCLUSION: In metastatic prostate cancer, radical prostatectomy results in lower cancer-specific mortality relative to external beam radiation therapy. Even after adjustment for age at diagnosis, prostate-specific antigen and biopsy Gleason grade grouping, lower cancer-specific mortality rates are recorded in radical prostatectomy patients than in external beam radiation therapy patients. As a result, radical prostatectomy should be considered as a treatment option in selected metastatic prostate cancer patients. However, further validation will be provided by ongoing clinical trials.
AB - OBJECTIVE: To test whether radical prostatectomy might result in better survival than external beam radiation therapy in metastatic prostate cancer patients.METHODS: Newly diagnosed metastatic prostate cancer patients with M1a/b substages, treated with radical prostatectomy or external beam radiation therapy were abstracted from the Surveillance, Epidemiology and End Results database (2004-2016). Temporal trend analyses, propensity score matching, cumulative incidence plots, multivariate competing risks regression models and landmark analyses were used.RESULTS: Of 4280 patients, 954 (22.3%) were treated with radical prostatectomy. After propensity score matching, 5-year cancer-specific mortality was 47.0 versus 53.0% in radical prostatectomy versus external beam radiation therapy patients (P = 0.003). In propensity score matched competing risks regression models, radical prostatectomy was associated with lower cancer-specific mortality versus external beam radiation therapy (hazard ratio 0.79, 95% confidence interval 0.79-0.90; P = 0.001). Finally, landmark analyses rejected the bias favoring radical prostatectomy. Finally, in subgroup analyses, we relied on selection criteria that most closely resembled the STAMPEDE criteria and a similar hazard ratio of 0.8 (P < 0.001) was recorded.CONCLUSION: In metastatic prostate cancer, radical prostatectomy results in lower cancer-specific mortality relative to external beam radiation therapy. Even after adjustment for age at diagnosis, prostate-specific antigen and biopsy Gleason grade grouping, lower cancer-specific mortality rates are recorded in radical prostatectomy patients than in external beam radiation therapy patients. As a result, radical prostatectomy should be considered as a treatment option in selected metastatic prostate cancer patients. However, further validation will be provided by ongoing clinical trials.
KW - Humans
KW - Male
KW - Neoplasm Grading
KW - North America
KW - Prostatectomy
KW - Prostatic Neoplasms/radiotherapy
KW - SEER Program
U2 - 10.1111/iju.14586
DO - 10.1111/iju.14586
M3 - SCORING: Journal article
C2 - 34047401
VL - 28
SP - 834
EP - 839
JO - INT J UROL
JF - INT J UROL
SN - 0919-8172
IS - 8
ER -
