Studies comparing radical prostatectomy (RP) to radiation therapy (RT) have consistently shown that patients undergoing RT have a higher risk of other-cause mortality (OCM) compared to RP, signifying poor health status of the former patients. We aimed to evaluate the impact of RP versus RT on cancer-specific mortality (CSM) over a cohort with equivalent OCM risk.
The SEER database was queried to identify patients with nonmetastatic PCa between 2004 and 2009. Patients were matched based on their calculated 10-year OCM risk and further stratified for D'Amico Risk Score and Gleason Grade. A Cox-regression model was used to calculate the 10-year OCM risk. Propensity-score based on the calculated OCM risk were used to match RP and RT patients. Cumulative incidence curves and Competing-risk regression analyses were used to examine the impact of treatment on CSM in the matched cohort.
We identified 55,106 PCa patients treated with RP and 36,674 treated with RT. After match, 6,506 patients were equally distributed for RT versus RP, with no difference in OCM rates (P = .2). The 10-year CSM rates were 8.8% versus 0.6% (P = .01) for RT versus RP in patients with unfavorable-intermediate-risk (Gleason Score 4 + 3) and 7.9% versus 3.9% (P = .003) for high-risk disease. There was no difference in CSM among RT and RP patients for favorable-intermediate-risk (Gleason Score 3 + 4) and low-risk disease.
In a matched cohort of PCa patients with comparable OCM between the 2 arms, RP yielded a more favorable CSM rate compared to RT only for unfavorable-intermediate- and high-risk groups.
Clinical genitourinary cancer. 2024 Aug 13 [Epub ahead of print]
Marco Finati, Nicholas James Corsi, Alex Stephens, Giuseppe Chiarelli, Giuseppe Ottone Cirulli, Matthew Davis, Shane Tinsley, Akshay Sood, Nicolò Buffi, Giovanni Lughezzani, Andrea Salonia, Alberto Briganti, Francesco Montorsi, Carlo Bettocchi, Giuseppe Carrieri, Craig Rogers, Firas Abdollah
VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI; Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy., VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI., Public Health Sciences, Henry Ford Health System, Detroit, MI., VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI; Department of Biomedical Sciences, Humanitas University, Milan, Italy., VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI; Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy., Department of Urology, University of Texas MD Anderson Cancer Centre, Houston, TX., Department of Biomedical Sciences, Humanitas University, Milan, Italy., Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy., Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy., VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI; Henry Ford Health, Detroit, MI., VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI; Henry Ford Health, Detroit, MI. Electronic address: .