Comparison of mortality outcomes after radical prostatectomy versus radiotherapy in patients with localized prostate cancer: A population-based analysis

Authors

  • Firas Abdollah,

    Corresponding author
    1. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Quebec, Canada
    2. Department of Urology, Vita Salute San Raffaele University, Milan, Italy
      Firas Abdollah M.D., Department of Urology, Urological Research Institute, San Raffaele Hospital, University Vita-Salute, Via Olgettina 60, Milan 20132, Italy. Email: firas.abdollah@gmail.com
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    • These authors contributed equally to this work.

  • Jan Schmitges,

    1. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Quebec, Canada
    2. Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
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    • These authors contributed equally to this work.

  • Maxine Sun,

    1. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Quebec, Canada
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  • Claudio Jeldres,

    1. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Quebec, Canada
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  • Zhe Tian,

    1. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Quebec, Canada
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  • Alberto Briganti,

    1. Department of Urology, Vita Salute San Raffaele University, Milan, Italy
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  • Shahrokh F Shariat,

    1. Department of Urology, Weill Medical College of Cornell University, New York, New York, USA
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  • Paul Perrotte,

    1. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Quebec, Canada
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  • Francesco Montorsi,

    1. Department of Urology, Vita Salute San Raffaele University, Milan, Italy
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  • Pierre I Karakiewicz

    1. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Quebec, Canada
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Firas Abdollah M.D., Department of Urology, Urological Research Institute, San Raffaele Hospital, University Vita-Salute, Via Olgettina 60, Milan 20132, Italy. Email: firas.abdollah@gmail.com

Abstract

Objectives:  To compare the mortality outcomes of radical prostatectomy and radiotherapy as treatment modalities for patients with localized prostate cancer.

Methods:  Our cohort consisted of 68 665 patients with localized prostate cancer, treated with radical prostatectomy or radiotherapy, between 1992 and 2005. Propensity-score matching was used to minimize potential bias related to treatment assignment. Competing-risks analyses tested the effect of treatment type on cancer-specific mortality, after accounting for other-cause mortality. All analyses were stratified according to prostate cancer risk groups, baseline Charlson Comorbidity Index and age.

Results:  For patients treated with radical prostatectomy versus radiotherapy, the 10-year cancer-specific mortality rates were 1.4 versus 3.9% in low-intermediate risk prostate cancer and 6.8 versus 11.5% in high-risk prostate cancer, respectively. Rates were 2.4 versus 5.9% in patients with Charlson Comorbidity Index of 0, 2.4 versus 5.1% in patients with Charlson Comorbidity Index of 1, and 2.9 versus 5.2% in patients with Charlson Comorbidity Index of ≥2. Rates were 2.1 versus 5.0% in patients aged 65–69 years, 2.8 versus 5.5% in patients aged 70–74 years, and 2.9 versus 7.6% in patients aged 75–80 years (all P < 0.001). At multivariable analyses, radiotherapy was associated with less favorable cancer-specific mortality in all categories (all P < 0.001).

Conclusions:  Patients treated with radical prostatectomy fare substantially better than those treated with radiotherapy. Patients with high-risk prostate cancer benefit the most from radical prostatectomy. Conversely, the lowest benefit was observed in patients with low-intermediate risk prostate cancer and/or multiple comorbidities. An intermediate benefit was observed in the other examined categories.

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