The impact of radical prostatectomy versus radiation therapy on cancer-specific mortality for patients with localized prostate cancer and positive nodal disease: An analysis of other cause mortality weighted cohort
Recommended Citation
Tinsley SA, Stephens A, Finati M, Chiarelli G, Cirulli GO, Davis M, Corsi N, Sood A, Buffi NM, Lughezzani G, Bettocchi C, Salonia A, Briganti A, Montorsi F, Carrieri G, Rogers CG, Abdollah F. The impact of radical prostatectomy versus radiation therapy on cancer-specific mortality for patients with localized prostate cancer and positive nodal disease: An analysis of other cause mortality weighted cohort. Eur Urol 2024; 85:S1261-S1262.
Document Type
Conference Proceeding
Publication Date
3-1-2024
Publication Title
Eur Urol
Abstract
Introduction & Objectives: There is controversy regarding the survival benefit of radical prostatectomy (RP) versus radiation therapy (RT) for the primary management for prostate cancer (PCa) in men with clinically positive nodes (cN1). Virtually, all previous retrospective reports on this subject are limited by selection bias, where “unhealthy” patients are more frequently treated with RT. To circumvent this limitation, we sought to compare prostate cancer specific mortality (PCSM) in cN1 PCa patients who underwent RP versus RT, in an othercause mortality (OCM) weighted cohort. Materials & Methods: The Surveillance, Epidemiology, and End Results (SEER) database was queried to identify men with cN1 PCa at diagnosis between 2004 to 2017, and were treated with RP or RT. A Cox regression model was used to calculate the 10-year OCM risk using all available covariates, including treatment type. Then, a competing risk multivariate model, which was weighted on the calculated OCM risk, was used to examine the impact of treatment type (RP vs. RT) on PCSM, after accounting for available covariates. Results: There were a total of 5778 patients included in our final cohort, with 4739 (82.02%) patients underwent RP, versus 1039 (17.98%) who underwent RT. The median with the interquartile range had a follow-up of 4.7 years (2.6-8.2). OCM has statistically significant differences between RP and RT patients in the unweighted (p-value = 0.005), but that difference disappeared in the weighted cohort (p-value = 0.2). Based on cumulative incidence function (CIF), the 10-year PCSM rate was 32.2% (95% CI: 27.6% - 35.6%) for patients treated with RT versus 17.1% (95% CI: 15.9% - 19.0%) for those that treated with RP (p-value <0.001). Conclusions: Our results show that cN1 PCa patients treated initially with RT fare worst in terms of PCSM than their counterparts that underwent RP. Our report is the first comparative effectiveness study that compares those treatments cohorts, after alleviating the known selection bias in “real-world” practice by weighting our models using calculated OCM. [Figure presented]
Volume
85
First Page
S1261
Last Page
S1262
