Editor's Commentary - Primary radiotherapy versus radical prostatectomy for high-risk prostate cancer: A decision analysis

BERKELEY, CA (UroToday.com) - Two recent reports from retrospective databases have suggested that the 10-year survival from high-risk prostate cancer (CaP) is better with surgery than radiotherapy.

However, in Cancer, Mr. Ravi Parikh and Dr. David Sher report a decision model that suggests radiotherapy with androgen deprivation therapy (ADT) or RT+ADT is superior to surgery with adjuvant radiotherapy (S+RT). The decision model was a Markov model to simulate three hypothetical cohorts of men with non-metastatic, high-risk CaP; Cohort 1 received RT+ADT, cohort 2 received S+RT, and cohort 3 received S+RT+ADT. Outcome probabilities were derived from published literature: RT+ADT from RTOG 92-02 and EORTC 22863, S+RT from SWOG 8794, and S+RT+ADT by multiplying the baseline risk of recurrence after S+RT by the hazard ratios for ADT derived from RTOG92-02 and RTOG 86-10. The risk of distant metastasis was also derived from RTOG 92-02 and the HR of local recurrence evolving into metastasis was 1.89. Toxicity was also derived from published literature. A sensitivity analysis permitted adjustment of the assumptions in the model.

The model predicted 10-year local recurrence and distant metastasis rates similar to the clinical trials, suggesting realistic estimation of outcomes. In the base case, the quality–adjusted life expectancy (QALE) for RT+ADT, S+RT and S+RT+ADT were 9.3, 8.0, and 9.5 quality-adjusted life years (QALYs), respectively. In the head-to-head comparison, RT+ADT was associated with in increase of 1.3 QALYs compared with S+RT. Applying different sensitivity analyses revealed that RT+ADT resulted in more than 1 QALY difference compared with S+RT. S+RT+ADT led to a higher QALE, but usually <1 QAL-month. Interestingly, if the all-cause mortality from ADT was included, then S+RT had a 1.2 QALE benefit over RT+ADT and 0.5 benefit over S+RT+ADT.


Cancer. 2011 Jun 30. Epub ahead of print.

PubMed Abstract
PMID: 21720990

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