Comparative effectiveness of radical prostatectomy and radiotherapy in prostate cancer: observational study of mortality outcomes

Abstract

Objective To compare the survival outcomes of patients treated with surgery or radiotherapy for prostate cancer. Design Observational study.Setting Sweden, 1996Sweden, -2010 Participants 34 515 men primarily treated for prostate cancer with surgery (n=21 533) or radiotherapy (n=12 982). Patients were categorised by risk group (low, intermediate, high, and metastatic), age, and Charlson comorbidity score. Main outcome measuresCumulative incidence of mortality from prostate cancer and other causes. Competing risks regression hazard ratios for radiotherapy versus surgery were computed without adjustment and after propensity score and traditional (multivariable) adjustments, as well as after propensity score matching. Several sensitivity analyses were performed.Results Prostate cancer mortality became a larger proportion of overall mortality as risk group increased for both the surgery and the radiotherapy cohorts. Among patients with non-metastatic prostate cancer the adjusted subdistribution hazard ratio for prostate cancer mortality favoured surgery (1.76, 95% confidence interval 1.49 to 2.08, for radiotherapy v prostatectomy), whereas there was no discernible difference in treatment effect among men with metastatic disease. Subgroup analyses indicated more clear benefits of surgery among younger and fitter men with intermediate and high risk disease. Sensitivity analyses confirmed the main findings.Conclusions This large observational study with follow-up to 15 years suggests that for most men with non-metastatic prostate cancer, surgery leads to better survival than does radiotherapy. Younger men and those with less comorbidity who have intermediate or high risk localised prostate cancer might have a greater benefit from surgery.

Prostate Cancer Registries: Current Status and Future Directions

“…In this context, studies based on several of these data sources have demonstrated that better outcomes might be achieved in high-volume hospitals and/or with more experienced surgeons [21,76]. The evaluation of large cohorts with follow-up data on cancer control has an important role in assessment of the safety and efficacy of PCa treatments [77][78][79][80][81][82][83][84][85][86][87][88][89][90][91][92][93][94]. Data on health-related quality of life after treatment can also be analyzed.…”

Surgery versus radiotherapy for localised prostate cancer

“…11 A total of 34 515 men made this study cohort, with a follow-up to 15 years (median 5.37 years). Subjects were classified by clinical risk (low, intermediate, high), age (<65, 65 or more) and Charlson score (0, 1 or more).…”

Cancer-specific mortality among Korean men with localized or locally advanced prostate cancer treated with radical prostatectomy versus radiotherapy: A multi-center study using propensity scoring and competing risk regression analyses

“…However, most of these studies were retrospective in nature, and were limited by methodological biases arising from differences in pretreatment patient and cancer risk features between treatment cohorts [9,10]. Therefore, their results were inconclusive and yielded only weak evidence regarding which treatment was superior in terms of oncological outcome.…”