Surgery versus radiation for clinically positive nodal prostate cancer in an other cause mortality risk weighted cohort

Authors

Shane Tinsley, Henry Ford HealthFollow
Alex StephensFollow
Marco Finati, Henry Ford HealthFollow
Giuseppe Chiarelli, Henry Ford HealthFollow
Giuseppe O. Cirulli, Henry Ford HealthFollow
Chase Morrison, Henry Ford HealthFollow
Caleb Richard, Henry Ford HealthFollow
Keinnan Hares, Henry Ford HealthFollow
Jonathan Lutchka, Henry Ford HealthFollow
Akshay Sood
Nicolò Buffi
Giovanni Lughezzani
Carlo Bettocchi
Andrea Salonia
Alberto Briganti
Francesco Montorsi
Giuseppe Carrieri
Craig G. Rogers, Henry Ford HealthFollow
Firas Abdollah, Henry Ford HealthFollow

Recommended Citation

Tinsley SA, Stephens A, Finati M, Chiarelli G, Cirulli GO, Morrison C, Richard C, Hares K, Lutchka J, Sood A, Buffi N, Lughezzani G, Bettocchi C, Salonia A, Briganti A, Montorsi F, Carrieri G, Rogers C, and Abdollah F. Surgery versus radiation for clinically positive nodal prostate cancer in an other cause mortality risk weighted cohort. Int Urol Nephrol 2024.

Document Type

Article

Publication Date

3-1-2025

Publication Title

International urology and nephrology

Abstract

PURPOSE: This study examined cancer control metrics between surgery and radiation for clinically positive nodal prostate cancer in an other-cause mortality weighted cohort, to circumvent limitations in previous studies.

METHODS: The Surveillance, Epidemiology, and End Results Research Plus database was queried to identify men with clinically positive nodal prostate cancer at diagnosis between 2004 and 2017 who were treated with surgery or radiation. A competing-risks regression model was used to calculate the 10-year other-cause mortality risk using available covariates, including treatment type. Inverse probability of treatment weighting was then used to balance covariates, including other-cause mortality risk. Then, competing-risks cumulative incidence curves and multivariable models, which were weighted on the calculated other-cause mortality risk, were used to examine the impact of treatment type on cancer-specific mortality, after accounting for covariates.

RESULTS: 4739 patients underwent surgery whereas 1039 underwent radiation. The median follow-up was 4.7 years (2.6-8.2). Other-cause mortality was statistically different between treatment arms in the unweighted cohort (Gray's p = 0.005), but that difference disappeared in the weighted cohort (Gray's p = 0.2). At 10 years, the cancer-specific mortality rate was 27.6% (22.2-33.9) for radiation versus 18.1% (16.2-20.3) for surgery (p < 0.001). On competing-risks multivariable analysis, radiation had 1.86-fold (95% CI 1.69-2.12) higher hazard likelihood from one year to the next compared to surgery (p < 0.001).

CONCLUSION: Clinically positive nodal patients treated with radiation fare worst cancer-specific mortality than those that underwent surgery, using calculated other-cause mortality risk.

Medical Subject Headings

Humans; Male; Prostatic Neoplasms; Aged; Middle Aged; Prostatectomy; Lymphatic Metastasis; Risk Assessment; Cohort Studies; Cause of Death; SEER Program

PubMed ID

39528898

ePublication

ePub ahead of print

Volume

57

Issue

3

First Page

825

Last Page

837