Survival after radical prostatectomy or radiotherapy for locally advanced (cT3) prostate cancer.

[pjoshea13]

New study below.

"Within the SEER database (2004-2014), we identified 5500 cT3N0-1 PCa patients."

"Ten-year {cancer-specific mortality} and {other cause of mortality} rates were significantly higher after {external beam radiotherapy} (15.8 and 28.2%) than {radical prostatectomy} (8.1 and 10.4%)."

"A lower CSM was recorded throughout the entire range of baseline PSA ..."

-Patrick

ncbi.nlm.nih.gov/pubmed/297...

World J Urol. 2018 May 2. doi: 10.1007/s00345-018-2310-y. [Epub ahead of print]

Survival after radical prostatectomy or radiotherapy for locally advanced (cT3) prostate cancer.

Bandini M1,2,3, Marchioni M4,5, Preisser F4,6, Zaffuto E7,8, Tian Z4, Tilki D6, Montorsi F7,8, Shariat SF9, Saad F4, Briganti A7,8, Karakiewicz PI4.

Author information

1

Division of Oncology/Unit of Urology URI, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, MI, Italy. [e-mail].

2

Vita-Salute San Raffaele University, Milan, Italy. [e-mail].

3

Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada. [e-mail].

4

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

5

Department of Urology, SS Annunziata Hospital, "G. D'Annunzio" University of Chieti, Chieti, Italy.

6

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

7

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

8

Vita-Salute San Raffaele University, Milan, Italy.

9

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

Abstract

PURPOSE:

No prospective data examined the effect of radical prostatectomy (RP) vs. external beam radiotherapy (EBRT) in locally advanced prostate cancer (PCa). We aimed to compare survival outcomes of RP and EBRT in patients harboring cT3N0-1 PCa.

METHODS:

Within the SEER database (2004-2014), we identified 5500 cT3N0-1 PCa patients. Cumulative incidence plots and competing-risks regression models (CRRs) tested cancer-specific mortality (CSM) and other cause of mortality (OCM) according to treatment type. The multivariable relationship between baseline prostate-specific antigen (PSA) values and 10-year CSM after either RP or EBRT was graphically depicted using the LOESS smoothing method. Sensitivity analyses were performed in cT3N0-only patients, after OCM propensity score matching, and through landmark analyses.

RESULTS:

Ten-year CSM and OCM rates were significantly higher after EBRT (15.8 and 28.2%) than RP (8.1 and 10.4%) (all p < 0.0001). In multivariable CRRs, RP yielded lower CSM [hazard ratio (HR): 0.64] than EBRT. Significantly lower 10-year CSM rate was recorded after RP vs. EBRT through the entire range of baseline PSA values. The same results were recorded in cT3N0 subgroup, as well as after OCM propensity score matching. Finally, landmark analyses at 6, 12, 24, and 36 months rejected the effect of favorable survival bias after RP.

CONCLUSIONS:

CSM was significantly lower after RP than EBRT in cT3N0-1 PCa. A lower CSM was recorded throughout the entire range of baseline PSA and even in cT3N0 subgroup, as well as after OCM propensity score matching and landmark analyses.

KEYWORDS:

External beam radiotherapy; Locally advanced disease; Prostate cancer; Radical prostatectomy; SEER program

PMID: 29717358 DOI: 10.1007/s00345-018-2310-y

[spinosa]

so, having a prostatectomy is better than radiation?

[pjoshea13 in reply to spinosa]

for those men in the SEER database (2004-2014), on average.

-Patrick

[kmack57]

Well, that does'nt make me feel to good about my choice to have radiation!

[snoraste]

This is consistent with other studies for this cohort. It seems that for more “advanced” cancer RP is a better route. If I remember correctly for less “advanced” it was a toss up, or slightly in favor of RT.

[pjoshea13 in reply to snoraste]

IMO, there are two hurdles faced by new patients: (i) lack of a comprehensive set of survival statistics, & (ii) lack of understanding that there is professional bias. The treatment one opts for is very much dependent on whom one sees. The AMA turns a blind eye to the situation, as though the choice doesn't really matter. The "choice" process is somewhat farcical. The patient is supposed to feel empowered. Being a cynic, I feel it is about pushing ownership of the decision onto the patient, so that the doctor isn't blamed when it doesn't work out well.

-Patrick

[Beermaker in reply to pjoshea13]

When I was diagnosed in 2011 (PSA 6.2, Gleason 7-9 depending on the core examined), I asked my urologist what to do . He said I should check around, talk to good doctors. He had a lot of experience in seed treatment, but would not recommend it based on my situation. I had to make my own choice (along with my wife.) After talking with a good urologist/oncologist for a good half hour, and with a radiologist for about the same amount of time, we discussed the options. The radiology place seemed much more interested in how I would pay than in what they could do. The urologist/oncologist laid out his opinion, and told us a fair amount about what to expect, but not everything. We still had to make a choice, and chose a robotic RP. If we had to do it over again, I would choose an open RP, but that is based on hindsight and knowledge gained since the operation.

Essentially, the choice was pushed on me, and the guidance I got was heavily skewed towards what the doctor could do. Each surgeon said cut, each radiologist said radiate. (I had a post surgery discussion with another radiologist who said to do nothing - guidelines have changed here.) I recommend talking to several doctors, and with your care giver, and researching what the upsides and downsides are for each approach. Having the choice is not all a bad thing.

[gusgold]

so basically cutting it out is better than trying to kill it

[Hidden]

I was told that RP would be too difficult after prior TURP surgery. I was directed toward radiation but chose HIFU instead. Not sure I want to know the 10 year CSM for HIFU. I think I will have a better quality of life than a lot of RP patients for however long I survive and I would think that has some bearing. I still think something other than PC will get me.

[j-o-h-n]

youtube.com/watch?v=zRZHKNH...(Not working as expected?)

Good Luck and Good Health.

j-o-h-n Friday 05/04/2018 5:19 PM EDT

[jimbob99999]

Is there a similar statistic for people with Stage 4? I am facing exactly this decision after Chemo and ADT has knocked PSA down to 0.9.