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. 2022 Jul;16(7):E391-E398.
doi: 10.5489/cuaj.7580.

Localized prostate cancer: An analysis of the Centers for Disease Control and Prevention Breast and Prostate Cancer Data Quality and Patterns of Care study (CDC PoC-BP)

Kenan Celtik  1 , Christopher J D Wallis  2 , Mary Lo  3 , Kelvin Lim  1 , Joseph Lipscomb  4 , Steven Fleming  5 , Xiao-Cheng Wu  6 , Roger T Anderson  7 , Trevor D Thompson  8 , Andrew Farach  9 , Ann S Hamilton  3 , Brian J Miles  1 , Raj Satkunasivam  1   10
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Localized prostate cancer: An analysis of the Centers for Disease Control and Prevention Breast and Prostate Cancer Data Quality and Patterns of Care study (CDC PoC-BP)

Kenan Celtik et al. Can Urol Assoc J. 2022 Jul.

Abstract

Introduction: Limited evidence exists on the comparative effectiveness of local treatments for prostate cancer (PCa) due to the lack of generalizability. Using granular national data, we sought to examine the association between radical prostatectomy (RP) and intensity-modulated radiation therapy (IMRT) treatment and survival.

Methods: Records were abstracted for localized PCa cases diagnosed in 2004 across seven state registries to identify patients undergoing RP (n=3019) or IMRT (n=667). Comorbidity was assessed by the Adult Comorbidity Evaluation-27 (ACE-27). Propensity score matching (PSM) was used to balance covariates between treatment groups. All-cause and PCa-specific mortality were primary endpoints. A subgroup analysis of patients with high-risk PCa (RP, n=89; IMRT, n=95) was conducted.

Results: Following PSM, matched patients (n=502 pairs) treated with either RP or IMRT were well-balanced with respect to covariates. With a median followup of 10.5 years (interquartile range [IQR] 9.9-11.0), the 11-year overall survival (OS) was 71.2% (95% confidence interval [CI] 66.9-75.8) for RP and 62.3% (95% CI 57.4-67.6) for IMRT. IMRT was associated with a 41% increased risk of all-cause mortality (hazard ratio [HR] 1.41, 95% CI 1.13-1.76) but not PCa-specific mortality (HR 1.75, 95% CI 0.84-3.64), as compared to RP. In patients with high-risk PCa, IMRT, as compared to RP, was not associated with a statistically significant difference in all-cause (HR 1.53, 95% CI 0.97-2.42) or PCa-specific mortality (HR 1.92, 95% CI 0.69-5.36).

Conclusions: Despite a low mortality rate at 10 years and possible residual confounding, we found a significantly increased risk of all-cause mortality but no PCa-specific mortality associated with IMRT as compared to RP in this population-based study.

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Conflict of interest statement

Competing interests: The authors do not report any competing personal or financial interests related to this work.

Figures

Figure 1
Figure 1
Overall survival of surgery and intensity-modulated radiation therapy (IMRT) treatment groups.
Figure 2
Figure 2
Cumulative incidence of prostate cancer and non-prostate cancer deaths in surgery and intensity-modulated radiation therapy (IMRT) treatment groups.
See this image and copyright information in PMC

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