These authors contributed equally to this work.
Comparison of mortality outcomes after radical prostatectomy versus radiotherapy in patients with localized prostate cancer: A population-based analysis
Article first published online: 10 MAY 2012
© 2012 The Japanese Urological Association
International Journal of Urology
Volume 19, Issue 9, pages 836–844, September 2012
How to Cite
Abdollah, F., Schmitges, J., Sun, M., Jeldres, C., Tian, Z., Briganti, A., Shariat, S. F., Perrotte, P., Montorsi, F. and Karakiewicz, P. I. (2012), Comparison of mortality outcomes after radical prostatectomy versus radiotherapy in patients with localized prostate cancer: A population-based analysis. International Journal of Urology, 19: 836–844. doi: 10.1111/j.1442-2042.2012.03052.x
- Issue published online: 23 AUG 2012
- Article first published online: 10 MAY 2012
- Received 29 December 2011; accepted 23 April 2012.; Online publication 10 May 2012
- competing-risks regression;
- prostatic neoplasms/mortality;
- prostatic neoplasms/therapy;
- radiotherapy/statistics and numerical data;
- United States/epidemiology
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.