Comparative effectiveness of surgery and radiotherapy for survival of patients with clinically localized prostate cancer: A population‑based coarsened exact matching retrospective cohort study

Abstract

Radical prostatectomy and radiotherapy are currently the main treatment options for localized prostate cancer. However, no large cohort study comparing surgery and radiation has been performed in Japan or Asia. The objective of the current study was to compare the survival outcomes of patients with clinically localized prostate cancer and in elderly and young patients receiving surgery and radiotherapy. The survival outcomes of patients with localized prostate cancer (age at diagnosis ≤79 years, clinical T1-3) initially treated with surgery or radiotherapy were retrospectively analyzed. Data were collected from the population-based cancer registry of the Kanagawa Prefecture, Japan. A 1:1 coarsened exact matching of age at diagnosis, clinical T stage and cancer differentiation was performed between the two treatment groups. Patients were also categorized into two subgroups by age using a cutoff of 70 years for analysis. The cohort comprised 4,810 patients aged 50-79 years. No significant difference in cancer-specific survival (CSS) was observed between the two groups (P= 0.612). However, the surgery group had significantly better overall survival (OS; P= 0.004). When stratified for age, similar tendencies were observed in the elderly group (aged 70-79 years; CSS, P=0.961 and OS, P=0.007). No significant difference in either CSS or OS was identified in the younger group (P=0.550 and P= 0.408, respectively). Intrinsic deaths were more likely to occur in elderly patients treated with radiotherapy than those undergoing surgery (69.3 vs. 78.2%; P= 0.128). The results indicated that surgery provided significantly better OS than radiotherapy, particularly among the elderly. However, no significant difference was observed in CSS. These results should be interpreted with caution, given that some important factors were unavailable in the present study, such as prostate-specific antigen values and Gleason scores. Prospective trials evaluating these therapies are warranted.

Radiation therapy compared to radical prostatectomy as first-line definitive therapy for patients with high-risk localised prostate cancer: An updated systematic review and meta-analysis

“…The selection process for the systematic review is shown in Figure 1 . With further assessment, according to inclusion and exclusion criteria, 27 studies were finally available for the systematic review and meta-analysis ( Table 1 ) [ 8–34 ].

Figure 1.

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“…EBRT alone or EBRT plus BT), 23 studies assessed OS and CSS. The quality assessment of the included studies according to the Newcastle-Ottawa scale is summarised in Table 2 [ 8–34 ]. In general, there were only two fair quality studies, while all 25 others had at least good quality ( Table 2 ).…”

A Web-Based Prediction Model for Cancer-Specific Survival of Elderly Patients With Hypopharyngeal Squamous Cell Carcinomas: A Population-Based Study

“…Most hypopharyngeal cancers are squamous cell carcinomas (HPSCC), which are less common than other head and neck malignancies and account for about 3–5% of squamous cell carcinomas of the head and neck. The incidence rate of cancer in the elderly increases with age and is higher in people over 65 ( 5 , 6 ). So as aging intensifies, the number of elderly with HPSCC is expected to rise in the future.…”