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Radical prostatectomy or radiotherapy reduce prostate cancer mortality in elderly patients: a population-based propensity score adjusted analysis

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Abstract

Purpose

Contemporary data regarding the effect of local treatment (LT) vs. non-local treatment (NLT) on cancer-specific mortality (CSM) in elderly men with localized prostate cancer (PCa) are lacking. Hence, we evaluated CSM rates in a large population-based cohort of men with cT1-T2 PCa according to treatment type.

Methods

Within the SEER database (2004–2014), we identified 44,381 men ≥ 75 years with cT1-T2 PCa. Radical prostatectomy and radiotherapy patients were matched and the resulting cohort (LT) was subsequently matched with NLT patients. Cumulative incidence and competing risks regression (CRR) tested CSM according to treatment type. Analyses were repeated after Gleason grade group (GGG) stratification: I (3 + 3), II (3 + 4), III (4 + 3), IV (8), and V (9-10).

Results

Overall, 4715 (50.0%) and 4715 (50.0%) men, respectively, underwent NLT and LT. Five and 7-year CSM rates for, respectively, NLT vs. LT patients were 3.0 and 5.4% vs. 1.5 and 2.1% for GGG II, 4.5 and 7.2% vs. 2.5 and 2.8% for GGG III, 7.1 and 10.0% vs. 3.5 and 5.1% for GGG IV, and 20.0 and 26.5% vs. 5.4 and 9.3% for GGG V patients. Separate multivariable CRR also showed higher CSM rates in NLT patients with GGG II [hazard ratio (HR) 3.3], GGG III (HR 2.6), GGG IV (HR 2.4) and GGG V (HR 2.6), but not in GGG I patients (p = 0.5).

Conclusions

Despite advanced age, LT provides clinically meaningful and statistically significant benefit relative to NLT. Such benefit was exclusively applied to GGG II to V but not to GGG I patients.

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Authors and Affiliations

  1. Division of Oncology/Unit of Urology URI, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, MI, Italy

    Marco Bandini, Giorgio Gandaglia, Nicola Fossati, Francesco Montorsi & Alberto Briganti

  2. Vita-Salute San Raffaele University, Milan, Italy

    Marco Bandini

  3. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada

    Marco Bandini, Raisa S. Pompe, Michele Marchioni, Zhe Tian, Fred Saad & Pierre I. Karakiewicz

  4. Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Raisa S. Pompe, Derya Tilki & Markus Graefen

  5. Department of Urology, SS Annunziata Hospital, “G. D’Annunzio” University of Chieti, Chieti, Italy

    Michele Marchioni

  6. Department of Urology, Medical University of Vienna, Vienna, Austria

    Shahrokh F. Shariat

Authors
  1. Marco Bandini
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  2. Raisa S. Pompe
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  3. Michele Marchioni
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  4. Zhe Tian
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  13. Pierre I. Karakiewicz
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Contributions

MB: Protocol/project development, Data collection or management, Data analysis, Manuscript writing/editing. RP: Data collection or management. MM: Manuscript writing/editing. ZT: Data analysis. GG: Manuscript writing/editing. NF: Data analysis. Dt: Data analysis. MG: Data collection or management. FM: Protocol/project development. SFS: Data collection or management. AB: Protocol/project development. FS: Manuscript writing/editing. PIK: Manuscript writing/editing, Protocol/project development.

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Correspondence to Marco Bandini.

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Bandini, M., Pompe, R.S., Marchioni, M. et al. Radical prostatectomy or radiotherapy reduce prostate cancer mortality in elderly patients: a population-based propensity score adjusted analysis. World J Urol 36, 7–13 (2018). https://doi.org/10.1007/s00345-017-2102-9

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  • DOI: https://doi.org/10.1007/s00345-017-2102-9

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