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Observational Study
. 2018 Oct 15;124(20):4010-4022.
doi: 10.1002/cncr.31726. Epub 2018 Sep 25.

Comparative effectiveness of radical prostatectomy with adjuvant radiotherapy versus radiotherapy plus androgen deprivation therapy for men with advanced prostate cancer

Thomas L Jang  1   2 , Neal Patel  1   2 , Izak Faiena  1   2 , Kushan D Radadia  1   2 , Dirk F Moore  1   2 , Sammy E Elsamra  1   2 , Eric A Singer  1   2 , Mark N Stein  1   2 , James A Eastham  3   4 , Peter T Scardino  3   4 , Yong Lin  1   2 , Isaac Y Kim  1   2 , Grace L Lu-Yao  5   6
Affiliations
Observational Study

Comparative effectiveness of radical prostatectomy with adjuvant radiotherapy versus radiotherapy plus androgen deprivation therapy for men with advanced prostate cancer

Thomas L Jang et al. Cancer. .

Abstract

Background: Men with locally advanced prostate cancer (LAPCa) or regionally advanced prostate cancer (RAPCa) are at high risk for death from their disease. Clinical guidelines support multimodal approaches, which include radical prostatectomy (RP) followed by radiotherapy (XRT) and XRT plus androgen deprivation therapy (ADT). However, there are limited data comparing these substantially different treatment approaches. Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data, this study compared survival outcomes and adverse effects associated with RP plus XRT versus XRT plus ADT in these men.

Methods: SEER-Medicare data were queried for men with cT3-T4N0M0 (LAPCa) or cT3-T4N1M0 (RAPCa) prostate cancer. Propensity score methods were used to balance cohort characteristics between the treatment arms. Survival analyses were analyzed with the Kaplan-Meier method and Cox proportional hazards models.

Results: From 1992 to 2009, 13,856 men (≥65 years old) were diagnosed with LAPCa or RAPCa: 6.1% received RP plus XRT, and 23.6% received XRT plus ADT. At a median follow-up of 14.6 years, there were 2189 deaths in the cohort, of which 702 were secondary to prostate cancer. Regardless of the tumor stage or the Gleason score, the adjusted 10-year prostate cancer-specific survival and 10-year overall survival favored men who underwent RP plus XRT over men who underwent XRT plus ADT. However, RP plus XRT versus XRT plus ADT was associated with higher rates of erectile dysfunction (28% vs 20%; P = .0212) and urinary incontinence (49% vs 19%; P < .001).

Conclusions: Men with LAPCa or RAPCa treated initially with RP plus XRT had a lower risk of prostate cancer-specific death and improved overall survival in comparison with those men treated with XRT plus ADT, but they experienced higher rates of erectile dysfunction and urinary incontinence.

Keywords: combined modality therapy; comparative effectiveness; hormone therapy; outcomes; population and observational studies; prostate cancer; radiation; surgery; survival.

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Conflict of interest statement

Conflict of Interest Disclosures:

Dr. Jang reports grants from National Cancer Institute (P30 CA-072720), grants from New Jersey Health Foundation, during the conduct of the study.

Dr. Scardino reports other from OPKO, outside the submitted work (Clinical Advisory Board); In addition, Dr. Scardino has a patent OPKO issued.

Dr. Stein reports personal fees from Merck, outside the submitted work;

All other authors declare no competing interests.

Figures

Figure 1a.
Figure 1a.
Adjusted Prostate Cancer-Specific Survival in Men undergoing Radical Prostatectomy with Adjuvant Radiotherapy versus Radiotherapy plus Androgen Deprivation Therapy, according to Tumor Stage
Figure 1b.
Figure 1b.
Adjusted Overall Survival in Men undergoing Radical Prostatectomy with Adjuvant Radiotherapy versus Radiotherapy plus Androgen Deprivation Therapy, according to Tumor Stage
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