PURPOSE: To assess survival following radical prostatectomy (RP), intensity modulated radiation therapy (IMRT) or conformal radiation therapy (CRT) versus no local therapy (NLT) for metastatic prostate cancer (MPCa), adjusting for patient comorbidity, androgen deprivation therapy (ADT) and other factors.
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MATERIALS AND METHODS: Men ≥66 with MPCa undergoing treatment by RP, IMRT, CRT or NLT identified from SEER-Medicare linked database (2004-2009). Multivariable Cox proportional hazards models, before and after inverse propensity score weighting, were used to assess all cause and PCa specific mortality. Competing risk regression analysis was used to assess PCa specific mortality.
RESULTS: Among 4069 men with MPCa, RP (n=47), IMRT (n=88), CRT (n=107) were selected as local therapy versus NLT (n=3827). RP was associated with a 52% (HR: 0.48, 95% CI: 0.27-0.85) reduction in the risk of PCa specific mortality, after adjusting for socio-demographic, primary tumour characteristics, comorbidity, ADT and bone radiation within 6 months of diagnosis. IMRT was associated with a 62% (HR: 0.38, 95% CI: 0.24-0.61) reduction in the risk of PCa specific mortality, respectively. CRT was not associated with improved survival compared to NLT. Propensity score weighting yielded comparable results. Competing risk analysis revealed a 42% (SHR: 0.58, 95% CI: 0.35-0.95) and 57% (SHR: 0.43, 95% CI: 0.27-0.68) reduction in the risk of PCa specific mortality for RP and IMRT.
CONCLUSIONS: Local therapy with RP and IMRT, but not CRT, was associated with a survival benefit in MPC and warrants prospective evaluation in clinical trials.
Satkunasivam R, Kim AE, Desai M, Nguyen MM, Quinn DI, Ballas L, Lewinger JP, Stern MC, Hamilton AS, Aron M, Gill IS. Are you the author?
USC Institute of Urology and Norris Comprehensive Cancer Center, Keck School of Medicine of USC, Los Angeles, CA; Department of Preventive Medicine, Keck School of Medicine of USC, Los Angeles, CA; Department of Medical Oncology and Norris Comprehensive Cancer Center, Keck School of Medicine of USC, Los Angeles, CA; Department of Radiation Oncology and Norris Comprehensive Cancer Center, Keck School of Medicine of USC, Los Angeles, CA.
Reference: J Urol. 2015 Feb 21. pii: S0022-5347(15)00394-8.