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Observational Study
. 2014 Feb 26:348:g1502.
doi: 10.1136/bmj.g1502.

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

Prasanna Sooriakumaran  1 , Tommy Nyberg, Olof Akre, Leif Haendler, Inge Heus, Mats Olsson, Stefan Carlsson, Monique J Roobol, Gunnar Steineck, Peter Wiklund
Affiliations
Observational Study

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

Prasanna Sooriakumaran et al. BMJ. .

Abstract

Objective: To compare the survival outcomes of patients treated with surgery or radiotherapy for prostate cancer.

Design: Observational study.

Setting: Sweden, 1996-2010.

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 measures: Cumulative 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.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that: none of the authors have support for the submitted work; none of the authors have relationships with any companies that might have an interest in the submitted work in the previous three years; none of the authors’ spouses, partners, or children have any financial relationships that may be relevant to the submitted work; and none of the authors have non-financial interests that may be relevant to the submitted work.

Figures

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Fig 1 Cumulative incidence function estimates of cancer specific and other cause mortality survival curves (n=34 515), stratified according to treatment type
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Fig 2 Forest plot depicting propensity score adjusted subdistribution hazard ratios (sHR) for radiotherapy versus radical prostatectomy for cancer specific mortality stratified by risk group, and substratified by age and Charlson comorbidity index score
See this image and copyright information in PMC

Comment in

References

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