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. 2015 Mar 5;10(3):e0119494.
doi: 10.1371/journal.pone.0119494. eCollection 2015.

Trends and outcome from radical therapy for primary non-metastatic prostate cancer in a UK population

David C Greenberg  1 , Artitaya Lophatananon  2 , Karen A Wright  1 , Kenneth R Muir  2 , Vincent J Gnanapragasam  3
Affiliations

Trends and outcome from radical therapy for primary non-metastatic prostate cancer in a UK population

David C Greenberg et al. PLoS One. .

Abstract

Background: Increasing proportions of men diagnosed with prostate cancer in the UK are presenting with non-metastatic disease. We investigated how treatment trends in this demographic have changed.

Patient and methods: Non-metastatic cancers diagnosed from 2000-2010 in the UK Anglian Cancer network stratified by age and risk group were analysed [n = 10,365]. Radiotherapy [RT] and prostatectomy [RP] cancer specific survival [CSS] were further compared [n = 4755].

Results: Over the decade we observed a fall in uptake of primary androgen deprivation therapy but a rise in conservative management [CM] and radical therapy [p<0.0001]. CM in particular has become the primary management for low-risk disease by the decade end [p<0.0001]. In high-risk disease however both RP and RT uptake increased significantly but in an age dependent manner [p<0.0001]. Principally, increased RP in younger men and increased RT in men ≥ 70y. In multivariate analysis of radically treated men both high-risk disease [HR 8.0 [2.9-22.2], p<0.0001] and use of RT [HR 1.9 [1.0-3.3], p = 0.024] were significant predictors of a poorer CSM. In age-stratified analysis however, the trend to benefit of RP over RT was seen only in younger men [≤ 60 years] with high-risk disease [p = 0.07]. The numbers needed to treat by RP instead of RT to save one cancer death was 19 for this group but 67 for the overall cohort.

Conclusion: This study has identified significant shifts in non-metastatic prostate cancer management over the last decade. Low-risk disease is now primarily managed by CM while high-risk disease is increasingly treated radically. Treatment of high-risk younger men by RP is supported by evidence of better CSM but this benefit is not evident in older men.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Proportions of men with non-metastatic cancer treated by different modalities in the Anglia Cancer Network from 2000–2010.
Fig 2
Fig 2. Proportions of men with non-metastatic cancer treated by different modalities and stratified by NICE risk group from 2000–2010.
Fig 3
Fig 3. Cumulative (A) Cancer specific and (B) Overall survival from radical prostatectomy and radical radiotherapy.
Dashed lines represent 95% confidence intervals.
Fig 4
Fig 4. Cumulative cancer specific survival from radical prostatectomy and radical radiotherapy in age stratified groups.
See this image and copyright information in PMC

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