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. 2020 Jul 29;11(19):5738-5745.
doi: 10.7150/jca.38323. eCollection 2020.

Cryotherapy shows no inferiority compared with radical Prostatectomy for low-risk and intermediate-risk localized Prostate Cancer: a real-world study from the SEER database

Kun Jin  1 , Shi Qiu  1   2 , Xiaonan Zheng  1 , Yanyan Li  1 , Shiyu Zhang  1 , Jiakun Li  1 , Xinyang Liao  1 , Xiang Tu  1 , Lu Yang  1 , Qiang Wei  1
Affiliations

Cryotherapy shows no inferiority compared with radical Prostatectomy for low-risk and intermediate-risk localized Prostate Cancer: a real-world study from the SEER database

Kun Jin et al. J Cancer. .

Abstract

Background: For localized prostate cancer (PCa) with a low disease burden, whole-gland resection seems like overtreatment, while focal therapy, including cryosurgery, can achieve similar outcomes. We aimed at comparing the long-term survival outcomes of cryotherapy and radical prostatectomy (RP) and further exploring whether RP can be replaced by cryosurgery for those with low-risk PCa. Methods: We conducted analyses from the Surveillance, Epidemiology, and End Results (SEER) database (2004-2015) and performed propensity score matching and used an instrumental variate to reduce the influence of bias and unmeasured confounders to the greatest extent. Results: In the multivariate regression, patients who received cryotherapy had higher risk of overall mortality (OM) (hazard ratio [HR] = 2.52, 95% confidence interval [CI] 1.99-3.20, p < 0.001), but no significant difference was observed in decreasing cancer-specific mortality (CSM) (HR = 1.38, 95% CI 0.63-3.03, p = 0.41) after adjusting the confounders. After propensity score matching, patients who underwent cryotherapy had higher OM and CSM rates (HR = 2.70 [95% CI 1.99-3.66, p < 0.001] and HR = 2.99 [95% CI 1.19-7.48, p = 0.02], respectively). In the IV-adjusted analyses, RP was superior to cryotherapy in decreasing OM (HR = 2.52, 95% CI 1.99-3.20), while no obvious decrease of CSM was observed in the comparison of RP and cryotherapy (HR = 1.38, 95% CI 0.63-3.03). The subgroup analyses showed that RP displayed an obvious benefit in decreasing CSM (HR = 5.02, 95% CI 1.30-19.39, p = 0.02) for those with a prostate-specific antigen (PSA) level higher than 10 ng/ml. Conclusion: RP ranked as the best treatment in regard to tumor control, but the advantages of cryotherapy became evident when taking functional and oncological outcomes into account, especially for low- and intermediate-risk PCa with low PSA levels.

Keywords: Cryotherapy; Localized; Prostate Cancer; Radical Prostatectomy.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exists.

Figures

Figure 1
Figure 1
Flowchart describing the selection of patients treated with local treatment or non-local treatment in the Surveillance, Epidemiology and End Results databases, 2004-2015. Abbreviation: RP: radical prostatectomy.
Figure 2
Figure 2
Subgroup analyses of OM and CSM in the comparison between RP and cryotherapy. (A) Subgroup analysis of OM in the comparison of RP and cryotherapy. (B) Subgroup analysis of CSM in the comparison of RP and cryotherapy. Abbreviations: OM: Overall mortality; CSM: Cancer specific mortality; RP: Radical prostatectomy; GS: Gleason Score; PSA: Prostate specific antigen; Q1-Q4: Quartile 1 - Quartile 4.
Figure 3
Figure 3
Kaplan-Meier survival curve of OS and CSS. (A) Kaplan-Meier survival curve of OS in the comparison of RP and cryotherapy. (B) Kaplan-Meier survival curve of CSS in the comparison of RP and cryotherapy. Abbreviations: OS: Overall survival; CSS: Cancer specific survival; RP: Radical prostatectomy.
See this image and copyright information in PMC

References

    1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA Cancer J Clin. 2017;67:7–30. - PubMed
    1. Ferlay J, Soerjomataram I, Dikshit R. et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136:E359–86. - PubMed
    1. Heidenreich A, Bellmunt J, Bolla M. et al. EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and treatment of clinically localised disease. Eur Urol. 2011;59:61–71. - PubMed
    1. Menon M, Dalela D, Jamil M. et al. Functional recovery, oncologic outcomes and postoperative complications 12 months following robot-assisted radical prostatectomy: follow-up of an evidence-based analysis comparing the Retzius sparing and standard approaches. J Urol. 2018;199:1210–7. - PubMed
    1. Hamdy FC, Donovan JL, Lane JA. et al. 10-Year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer. New Engl J Med. 2016;375:1415–24. - PubMed