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PD43-02 COMPARATIVE EFFECTIVENESS OF SURGERY AND RADIATION THERAPY FOR HIGH RISK PROSTATE CANCER PATIENTS
THE JOURNAL OF UROLOGYâ
Vol. 193, No. 4S, Supplement, Monday, May 18, 2015
e891
Prostate Cancer: Localized VI Podium 43 Monday, May 18, 2015
1:00 PM-3:00 PM
PD43-01 LONG-TERM COMPARATIVE MORTALITY OUTCOMES ACROSS DIFFERENT PRIMARY TREATMENTS FOR PROSTATE CANCER Matthew Cooperberg*, SAN FRANCISCO, CA; Peter Carroll, San Francisco, CA INTRODUCTION AND OBJECTIVES: Randomized trials comparing different active treatments for localized prostate cancer have not been completed, although a number of studies in recent years have reported comparative outcomes using a variety of data sources, generally focusing of surgery and external-beam radiation. We analyzed extended followup in a large, community-based disease registry, comparing cancer-specific mortality across all major treatment alternatives. METHODS: Data were abstracted from CaPSURE, a prostate cancer registry which has been collecting data on men managed at a total of 47 clinical sites, primarily community-based, across the U.S. since 1995. Primary treatment was determined, and cancer-specific mortality (CSM) was assessed using a Weibull regression model adjusting for age and risk as summarized by the CAPRA score or the Kattan preoperative nomogram. RESULTS: Of 9912 men with known treatment and complete risk stratification data, 426 (4.3%) died of prostate cancer, at a median 86 months after diagnosis. Median followup for censored men was 61 months. Figure 1 illustrates unadjusted Kaplan-Meier plots by treatment, with mortality rates rising sharply beyond 12 years followup. The results of the adjusted analysis are shown in Figure 2, which indicates likelihood of 15-year CSM by primary treatment over a range of risk scores. CSM was unlikely for low-risk disease regardless of treatment, but for higher risk disease substantial differences were seen, favoring local treatment in general and radical prostatectomy in particular. Brachytherapy and external-beam radiation yielded similar results. Primary hormonal therapy results were similar to those seen for active surveillance. CONCLUSIONS: These results support a management paradigm including active surveillance for most men with low risk disease and aggressive multimodal treatment including surgery for men with high-risk prostate cancer.
Source of Funding: None
PD43-02 COMPARATIVE EFFECTIVENESS OF SURGERY AND RADIATION THERAPY FOR HIGH RISK PROSTATE CANCER PATIENTS Ravishankar Jayadevappa*, Sumedha Chhatre, Alan Wein, S. Bruce Malkowicz, David Lee, Philadelphia, PA INTRODUCTION AND OBJECTIVES: To determine the five year survival impact of primary surgery compared to radiation therapy in older men with high risk prostate cancer METHODS: This was a population-based cohort study using Surveillance, Epidemiology, and End Results (SEER)-Medicare patients 66 years or older. Inclusion criteria for high risk prostate cancer are PSA> 20 ng/ml, or a Gleason score of > 8, or clinical stage T2c. Other inclusion criteria are diagnosis of prostate cancer between 2001 and 2002 and treated with definitive local (curative intent) therapy (surgery or radiation therapy) within 180 days of high risk prostate cancer diagnosis. The two treatment groups were retrospectively followed for one year pre and five years post diagnosis. Main outcome measure was five year all-cause mortality. Propensity score approach analysis was used to assess the impact of surgery/radiation therapy and control for potential biases associated with measured confounding variables. Sequential Cox regression was used to assess the hazard of mortality associated with treatment group in follow-up period. RESULTS: We identified a cohort of 14,140 men newly diagnosed for high risk for prostate cancer between 2001 and 2002. Thirty percent of these had surgery (n¼6047) and 45% had radiation therapy (n¼8093) as a primary treatment with curative intent within 180 days of diagnosis. Mean age at diagnosis of radiation group (mean¼74.08, sd¼5.4) was higher compared to surgery group (mean¼71.06, sd¼5.5). Radiation therapy group had higher comorbidity compared to surgery group. Unadjusted all-cause mortality comparison over five years of follow-up showed surgery treatment was associated with lower mortality (HR¼0.70, CI¼0.64, 0.76). However, propensity score adjusted allcause five year mortality (HR¼1.04, CI¼0.98, 1.11) was comparable between treatment groups. CONCLUSIONS: With a mean follow-up of 60 months, primary surgery and radiation therapy were comparable in terms of improved overall survival. Additional research is needed to identify the clinical, hospital and physician, and cost level factors associated with mortality for high risk prostate cancer patients. Source of Funding: None
Vol. 193, No. 4S, Supplement, Monday, May 18, 2015
e891
Prostate Cancer: Localized VI Podium 43 Monday, May 18, 2015
1:00 PM-3:00 PM
PD43-01 LONG-TERM COMPARATIVE MORTALITY OUTCOMES ACROSS DIFFERENT PRIMARY TREATMENTS FOR PROSTATE CANCER Matthew Cooperberg*, SAN FRANCISCO, CA; Peter Carroll, San Francisco, CA INTRODUCTION AND OBJECTIVES: Randomized trials comparing different active treatments for localized prostate cancer have not been completed, although a number of studies in recent years have reported comparative outcomes using a variety of data sources, generally focusing of surgery and external-beam radiation. We analyzed extended followup in a large, community-based disease registry, comparing cancer-specific mortality across all major treatment alternatives. METHODS: Data were abstracted from CaPSURE, a prostate cancer registry which has been collecting data on men managed at a total of 47 clinical sites, primarily community-based, across the U.S. since 1995. Primary treatment was determined, and cancer-specific mortality (CSM) was assessed using a Weibull regression model adjusting for age and risk as summarized by the CAPRA score or the Kattan preoperative nomogram. RESULTS: Of 9912 men with known treatment and complete risk stratification data, 426 (4.3%) died of prostate cancer, at a median 86 months after diagnosis. Median followup for censored men was 61 months. Figure 1 illustrates unadjusted Kaplan-Meier plots by treatment, with mortality rates rising sharply beyond 12 years followup. The results of the adjusted analysis are shown in Figure 2, which indicates likelihood of 15-year CSM by primary treatment over a range of risk scores. CSM was unlikely for low-risk disease regardless of treatment, but for higher risk disease substantial differences were seen, favoring local treatment in general and radical prostatectomy in particular. Brachytherapy and external-beam radiation yielded similar results. Primary hormonal therapy results were similar to those seen for active surveillance. CONCLUSIONS: These results support a management paradigm including active surveillance for most men with low risk disease and aggressive multimodal treatment including surgery for men with high-risk prostate cancer.
Source of Funding: None
PD43-02 COMPARATIVE EFFECTIVENESS OF SURGERY AND RADIATION THERAPY FOR HIGH RISK PROSTATE CANCER PATIENTS Ravishankar Jayadevappa*, Sumedha Chhatre, Alan Wein, S. Bruce Malkowicz, David Lee, Philadelphia, PA INTRODUCTION AND OBJECTIVES: To determine the five year survival impact of primary surgery compared to radiation therapy in older men with high risk prostate cancer METHODS: This was a population-based cohort study using Surveillance, Epidemiology, and End Results (SEER)-Medicare patients 66 years or older. Inclusion criteria for high risk prostate cancer are PSA> 20 ng/ml, or a Gleason score of > 8, or clinical stage T2c. Other inclusion criteria are diagnosis of prostate cancer between 2001 and 2002 and treated with definitive local (curative intent) therapy (surgery or radiation therapy) within 180 days of high risk prostate cancer diagnosis. The two treatment groups were retrospectively followed for one year pre and five years post diagnosis. Main outcome measure was five year all-cause mortality. Propensity score approach analysis was used to assess the impact of surgery/radiation therapy and control for potential biases associated with measured confounding variables. Sequential Cox regression was used to assess the hazard of mortality associated with treatment group in follow-up period. RESULTS: We identified a cohort of 14,140 men newly diagnosed for high risk for prostate cancer between 2001 and 2002. Thirty percent of these had surgery (n¼6047) and 45% had radiation therapy (n¼8093) as a primary treatment with curative intent within 180 days of diagnosis. Mean age at diagnosis of radiation group (mean¼74.08, sd¼5.4) was higher compared to surgery group (mean¼71.06, sd¼5.5). Radiation therapy group had higher comorbidity compared to surgery group. Unadjusted all-cause mortality comparison over five years of follow-up showed surgery treatment was associated with lower mortality (HR¼0.70, CI¼0.64, 0.76). However, propensity score adjusted allcause five year mortality (HR¼1.04, CI¼0.98, 1.11) was comparable between treatment groups. CONCLUSIONS: With a mean follow-up of 60 months, primary surgery and radiation therapy were comparable in terms of improved overall survival. Additional research is needed to identify the clinical, hospital and physician, and cost level factors associated with mortality for high risk prostate cancer patients. Source of Funding: None