Top

Published in:

01-09-2018 | Original Article

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

Authors: Marco Bandini, Michele Marchioni, Felix Preisser, Emanuele Zaffuto, Zhe Tian, Derya Tilki, Francesco Montorsi, Shahrokh F. Shariat, Fred Saad, Alberto Briganti, Pierre I. Karakiewicz

Published in: World Journal of Urology | Issue 9/2018

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.

Available only for authorised users

Ward JF, Slezak JM, Blute ML et al (2005) Radical prostatectomy for clinically advanced (cT3) prostate cancer since the advent of prostate-specific antigen testing: 15-year outcome. BJU Int 95:751–756. https://doi.org/10.1111/j.1464-410X.2005.05394.x CrossRefPubMed

Lardas M, Liew M, van den Bergh RC et al (2017) Quality of life outcomes after primary treatment for clinically localised prostate cancer: a systematic review. Eur Urol 72:869–885. https://doi.org/10.1016/j.eururo.2017.06.035 CrossRefPubMed

Professionals SO Prostate cancer. In: Uroweb. http://uroweb.org/guideline/prostate-cancer/#5. Accessed 25 Mar 2018

Mitchell CR, Boorjian SA, Umbreit EC et al (2012) 20-Year survival after radical prostatectomy as initial treatment for cT3 prostate cancer. BJU Int 110:1709–1713. https://doi.org/10.1111/j.1464-410X.2012.11372.x CrossRefPubMed

Hsu CY, Wildhagen MF, Van Poppel H, Bangma CH (2010) Prognostic factors for and outcome of locally advanced prostate cancer after radical prostatectomy. BJU Int 105:1536–1540. https://doi.org/10.1111/j.1464-410X.2009.09054.x CrossRefPubMed

Yamamoto S, Kawakami S, Yonese J et al (2014) Long-term oncological outcome in men with T3 prostate cancer: radical prostatectomy versus external-beam radiation therapy at a single institution. Int J Clin Oncol 19:1085–1091. https://doi.org/10.1007/s10147-013-0654-2 CrossRefPubMed

Boorjian SA, Karnes RJ, Viterbo R et al (2011) Long-term survival after radical prostatectomy versus external-beam radiotherapy for patients with high-risk prostate cancer. Cancer 117:2883–2891. https://doi.org/10.1002/cncr.25900 CrossRefPubMedPubMedCentral

Pilepich MV, Winter K, Lawton CA et al (2005) Androgen suppression adjuvant to definitive radiotherapy in prostate carcinoma–long-term results of phase III RTOG 85-31. Int J Radiat Oncol Biol Phys 61:1285–1290. https://doi.org/10.1016/j.ijrobp.2004.08.047 CrossRefPubMed

Noone AM, Cronin KA, Altekruse SF et al (2017) Cancer incidence and survival trends by subtype using data from the surveillance epidemiology and end results program, 1992–2013. Cancer Epidemiol Biomark Prev 26:632–641. https://doi.org/10.1158/1055-9965.EPI-16-0520 CrossRef

10.

National cancer institute surveillance, epidemiology, and end results prostate-specific antigen working group, Adamo MP, Boten JA et al (2017) Validation of prostate-specific antigen laboratory values recorded in surveillance, epidemiology, and end results registries. Cancer 123:697–703. https://doi.org/10.1002/cncr.30401 CrossRef

11.

Bandini M, Pompe RS, Marchioni M et al (2017) Radical prostatectomy or radiotherapy reduce prostate cancer mortality in elderly patients: a population-based propensity score adjusted analysis. World J Urol. https://doi.org/10.1007/s00345-017-2102-9 CrossRefPubMed

12.

Leyh-Bannurah SR, Budäus L, Zaffuto E et al (2017) Adherence to pelvic lymph node dissection recommendations according to the national comprehensive cancer network pelvic lymph node dissection guideline and the D’Amico lymph node invasion risk stratification. Urol Oncol. https://doi.org/10.1016/j.urolonc.2017.10.022 CrossRefPubMed

13.

Rusthoven CG, Waxweiler TV, DeWitt PE et al (2015) Gleason stratifications prognostic for survival in men receiving definitive external beam radiation therapy for localized prostate cancer. Urol Oncol 33(71):e11–e19. https://doi.org/10.1016/j.urolonc.2014.07.010 CrossRef

14.

Bandini M, Preisser F, Nazzani S et al (2018) Contemporary trends and survival outcomes after aborted radical prostatectomy in lymph node metastatic prostate cancer patients. Eur Urol Focus. https://doi.org/10.1016/j.euf.2018.01.009 CrossRefPubMed

15.

Epstein JI, Zelefsky MJ, Sjoberg DD et al (2016) A contemporary prostate cancer grading system: a validated alternative to the Gleason score. Eur Urol 69:428–435. https://doi.org/10.1016/j.eururo.2015.06.046 CrossRefPubMed

16.

Logan BR, Zhang MJ (2013) The use of group sequential designs with common competing risks tests. Stat Med 32:899–913. https://doi.org/10.1002/sim.5597 CrossRefPubMed

17.

Scrucca L, Santucci A, Aversa F (2010) Regression modeling of competing risk using R: an in depth guide for clinicians. Bone Marrow Transplant 45:1388–1395. https://doi.org/10.1038/bmt.2009.359 CrossRefPubMed

18.

Cleveland WS, Devlin SJ (1988) Locally weighted regression: an approach to regression analysis by local fitting. J Am Stat Assoc 83:596–610. https://doi.org/10.1080/01621459.1988.10478639 CrossRef

19.

Mnatzaganian G, Davidson DC, Hiller JE, Ryan P (2015) Propensity score matching and randomization. J Clin Epidemiol 68:760–768. https://doi.org/10.1016/j.jclinepi.2015.01.002 CrossRefPubMed

20.

Anderson JR, Cain KC, Gelber RD (1983) Analysis of survival by tumor response. J Clin Oncol 1:710–719. https://doi.org/10.1200/JCO.1983.1.11.710 CrossRefPubMed

21.

Hager B, Kraywinkel K, Keck B et al (2017) Increasing use of radical prostatectomy for locally advanced prostate cancer in the USA and Germany: a comparative population-based study. Prostate Cancer Prostatic Dis 20:61–66. https://doi.org/10.1038/pcan.2016.43 CrossRefPubMed

22.

Zelefsky MJ, Eastham JA, Cronin AM et al (2010) Metastasis after radical prostatectomy or external beam radiotherapy for patients with clinically localized prostate cancer: a comparison of clinical cohorts adjusted for case mix. J Clin Oncol 28:1508–1513. https://doi.org/10.1200/JCO.2009.22.2265 CrossRefPubMedPubMedCentral

23.

Kupelian PA, Elshaikh M, Reddy CA et al (2002) Comparison of the efficacy of local therapies for localized prostate cancer in the prostate-specific antigen era: a large single-institution experience with radical prostatectomy and external-beam radiotherapy. J Clin Oncol 20:3376–3385. https://doi.org/10.1200/JCO.2002.01.150 CrossRefPubMed

24.

Akakura K, Suzuki H, Ichikawa T et al (2006) A randomized trial comparing radical prostatectomy plus endocrine therapy versus external beam radiotherapy plus endocrine therapy for locally advanced prostate cancer: results at median follow-up of 102 months. Jpn J Clin Oncol 36:789–793. https://doi.org/10.1093/jjco/hyl115 CrossRefPubMed

25.

Arcangeli G, Strigari L, Arcangeli S et al (2009) Retrospective comparison of external beam radiotherapy and radical prostatectomy in high-risk, clinically localized prostate cancer. Int J Radiat Oncol Biol Phys 75:975–982. https://doi.org/10.1016/j.ijrobp.2008.12.045 CrossRefPubMed

26.

Gabriele D, Collura D, Oderda M et al (2016) Is there still a role for computed tomography and bone scintigraphy in prostate cancer staging? An analysis from the EUREKA-1 database. World J Urol 34:517–523. https://doi.org/10.1007/s00345-015-1669-2 CrossRefPubMed

Title: Survival after radical prostatectomy or radiotherapy for locally advanced (cT3) prostate cancer
Authors: Marco Bandini
Michele Marchioni
Felix Preisser
Emanuele Zaffuto
Zhe Tian
Derya Tilki
Francesco Montorsi
Shahrokh F. Shariat
Fred Saad
Alberto Briganti
Pierre I. Karakiewicz
Publication date: 01-09-2018
Publisher: Springer Berlin Heidelberg
Published in: World Journal of Urology / Issue 9/2018
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-018-2310-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 9/2018

The relationship between HPV status and chemoradiotherapy in the locoregional control of penile cancer

Parental awareness of testicular torsion amongst Irish parents

Predictors of surgical intervention following initial surveillance for acute ureteric colic

Cost-effectiveness of antimicrobial prophylaxis for children in the RIVUR trial

Suprapubic versus urethral catheter drainage in robotic-assisted laparoscopic prostatectomy: advancing systematic review quality

Local staging with multiparametric MRI in daily clinical practice: diagnostic accuracy and evaluation of a radiologic learning curve