EAU 2014 - Survival benefit of radical prostatectomy in patients with clinically advanced prostate cancer: Estimations of the number needed to treat based on competing-risks analysis - Session Highlights

STOCKHOLM, SWEDEN (UroToday.com) - The aim of this multicenter study was to examine the survival benefit associated with radical prostatectomy (RP), as compared to initial observation, in patients with clinically advanced prostate cancer.

In this Surveillance, Epidemiology, and End Results (SEER) study, authors used competing-risks analyses to estimate cancer-specific mortality (CSM) rates of 1 382 patients treated with radical prostatectomy (RP) and to compared it to patients treated with initial observation for clinically advanced prostate cancer (clinical stage T3/T4). They used propensity-score methodology to match the baseline characteristics of both treatment groups (RP vs observation). They calculated the 10-year cancer-specific mortality (CSM) rates and the number needed to treat (NNT). All analyses were performed after stratifying patients according to Gleason score (≤ 7 vs 8-10) and clinical stage (T3a vs T3b/T4).

eauOverall, 908 (65.7%) and 474 (34.3%) patients were treated with observation and RP. When patients were stratified according to initial treatment (observation vs RP), statistically significant differences were recorded with respect to age at diagnosis, race, marital status, CCI, Gleason score, clinical stage, and year of diagnosis (all P < 0.001). Following propensity-score matching, 474 (50%) patients receiving initial observation and 474 (50%) patients treated with RP remained. Overall, the 10-year CSM rates were 11.8 vs 19.3% for patients treated with RP vs initial observation, respectively (p < 0.001). The corresponding 10-year NNT was 13. The 10-year CSM rates for the same respective treatment groups were 8.9% vs 13.9% for Gleason score ≤ 7, 16.8% vs 27.8% for Gleason score 8-10, 10.1% vs 15.8% for clinical stage T3a, and 17.0% vs 29.3% for clinical stage T3b/T4, respectively (all P ≤ 0.04). The corresponding NNTs were 20, 9, 17, and 8, respectively. In multivariable analyses, it was found that RP was an independent predictor of favorable CSM in all categories (all p≤ 0.04).

The authors concluded that compared to observation, RP provides a significant survival advantage for treatment of locally advanced prostate cancer, with the highest survival benefit seen in patients with clinical stage T3b/T4 and Gleason score 8-10 PCa.

Presented by G.Gandaglia, M. Sun, V. Trudeau, F. Roghmann, M. Meskawi, A. Becker, P. Perrotte, Z.Tian, J. Schiffmann, M. Azizi, P. I. Karakiewicz, and F. Abdollah at the 29th Annual European Association of Urology (EAU) Congress - April 11 - 15, 2014 - Stockholmsmässan - Stockholm, Sweden.

Urological Research Institute, University Vita-Salute San Raffaele, Dept. of Urology, Milan, Italy; Cancer Prognostic and Health Outcomes, Dept. of Urology, Montreal, Canada

Written by Reza Mehrazin, MD, medical writer for UroToday.com