Localized prostate cancer survival outcomes better with radical prostatectomy than radiation therapy in large study
Overall, disease-specific mortality lower with surgery at 15-year follow-up
In addition, the benefits of surgery are greatest in younger men, healthier men, and those with high-risk disease, reported senior author David F. Penson, MD, MPH, at the AUA annual meeting in Atlanta.
"We undertook this analysis because to date there are no completed, adequately sized randomized controlled trials comparing RP to radiotherapy for treatment of localized prostate cancer. While PCOS is not randomized, our methods included appropriate techniques for risk adjustment, and we also undertook analyses of selected subgroups identified a priori to see if we could identify features to inform clinical decisions," said Dr. Penson, professor of urologic surgery, Vanderbilt University Medical Center, Nashville, TN.
"We acknowledge that the findings of our study could be due to residual confounding and that radiation therapy for men in this study was performed using older techniques with lower doses and underutilization of adjuvant androgen deprivation therapy, especially in high-risk patients. However, we think it is also possible that surgery is truly more effective than radiation in prolonging survival for men with localized prostate cancer."
PCOS is a population-based longitudinal study of patients from six Surveillance, Epidemiology, and End Results tumor registries enrolled between October 1994 and October 1995. The analyses presented by Dr. Penson included data from 1,655 men ages 55 to 74 years at diagnosis who had clinically localized disease (T1 or T2) and primary therapy with prostatectomy (1,164 men) or EBRT (491 men). They were identified from an initial 50% random sample of the entire PCOS population of 11,344 men.
A propensity score analysis was performed to control for treatment selection bias, and a multivariate Cox regression model, including baseline measures and propensity score as covariates, was used to compare the two treatment groups for 15-year overall and disease-specific survival rates. At baseline, the two treatment groups were comparable for clinical stage, PSA, and biopsy Gleason score, but there were significant differences between the groups in age at diagnosis, race/ethnicity, percent with comorbidities, insurance status, and by region.
EBRT mortality rate nearly double that of RP
In an unadjusted survival curve analysis, the 15-year overall mortality rate was nearly twice as high for the EBRT patients than for the surgery group (51% vs. 28%, respectively), and there was a threefold difference in the 15-year disease-specific mortality rate (12% vs. 4%, respectively).
In the adjusted analysis, risks of overall mortality and disease-specific mortality were significantly lower (40% and 65%, respectively) in the surgery patients compared with the EBRT group. Overall mortality and disease-specific mortality rates determined in sensitivity analyses using other multivariate statistical approaches conducted to confirm the validity of the propensity score were essentially the same. Age, number of comorbidities, Gleason score, stage, log PSA, propensity score, education, Hispanic race, and registry were also independent predictors of overall mortality. Gleason score, stage, and log PSA independently predicted disease-specific mortality in the adjusted analysis.
Planned subgroup analyses compared outcomes after prostatectomy and EBRT for men stratified by age (55-64 years and 65-74 years), risk group (low and high), and comorbidity status (none and any). In the analysis of the high-risk subgroup, EBRT patients were only included if they received androgen deprivation therapy.
In all of the subgroups except the low-risk cohort, surgery significantly reduced the risks of overall mortality by between 21% and 54% and disease-specific mortality by between 46% and 82%; the 82% reduced risk of cancer-specific mortality was observed both among younger men (ages 55 to 64 years) and those with no reported comorbidities.
MORE ARTICLES IN THIS ISSUE
The newest urology products and services from the Interstitial Cystitis Network, Wiley-Blackwell, and Medline Industries, Inc.
Repeat intradetrusor injections of onabotulinumtoxinA (Botox) are associated with sustained efficacy and no new safety signals.
Urologists find HIFU promising, but remain cautious
Some 190,000 men in the U.S. with non-metastatic prostate cancer were receiving continuous androgen deprivation therapy (ADT) at the end of 2008.
While on the surface, it may not seem to matter, there are some important differences between debit and credit cards, and reasons why you should use one form of payment over the other.
Androgen deprivation therapy (ADT) prior to salvage cryoablation appears to improve post-treatment morbidity to some extent but does not affect biochemical-free survival.
Widespread PSA screening appears to lead to improvements in pathologic outcomes.
People, whether they need their car fixed or treatment for a urologic condition, expect high-quality service, and they are disappointed when their expectations aren't met.
Whenever an employee leaves, you incur expenses to advertise the open position and set up and train a new employee. And, of course, there can be productivity losses in the interim.
Results of a retrospective study provide evidence supporting the use of ultrasound as follow-up imaging to detect relapses in patients with germ cell tumors (GCT).
With all of the pressure on the federal government to curtail spending, the U.S. Department of Health and Human Services (HHS) is not kidding around when it comes to investigating and prosecuting Medicare fraud and abuse.
Here are the take-home messages from the 2012 AUA annual meeting—cutting-edge research findings in 15 areas of clinical urology.
Already approved for neurogenic overactive bladder, onabotulinumtoxinA (Botox) may now be on its way to garnering an indication for idiopathic OAB.
In a recent audit of urodynamics charges, Medicare recognized some codes but not others, and the documentation for all services that were reviewed only included the report from the urodynamics machine. This review pointed out the lack of understanding of these codes by payers and physicians.
PSA is performing appropriately, allowing us to diagnose prostate cancers at an earlier stage and grade and allowing treatment while cure is still possible.
The American Association of Clinical Urologists (AACU) rejects the USPSTF's complete disregard of the positive effect the PSA test has had on so many men in this country.
Patients being treated with oral anticancer drugs for metastatic renal cell carcinoma (mRCC) demonstrate almost full adherence to their medication regimen, data show.
Treatment with the dual 5-alpha- reductase inhibitor dutasteride (Avodart) does not compromise the utility of PSA to detect progression of disease in patients with low-risk localized prostate cancer who are being managed with active surveillance.
PSA screening is on the rise and varies according to age, family history, race/ethnicity, and insurance status.
Most urologists say they've already seen reaction to the report's release and the resulting news coverage. Many are concerned that the USPSTF recommendation will give men another excuse to avoid the doctor's office.
Combining the results of the diagnostic and first-surveillance prostate biopsies provides useful information about the risk of progression in patients being managed by active surveillance.
Urology drugs and devices in the pipeline from Janssen Research and Development, LLC; Auxilium Pharmaceuticals, Inc.; Tengion Inc.; Ampio Pharmaceuticals, Inc.; Tokai Pharmaceuticals, ImaginAb, Inc.; BZL Biologics, LLC; Agensys, Inc.; and Seattle Genetics, Inc.