Trends and outcome from radical therapy for primary non-metastatic prostate cancer in a UK population - Abstract

BACKGROUND: Increasing proportions of men diagnosed with prostate cancer in the UK are presenting with non-metastatic disease.

We investigated how treatment trends in this demographic have changed.

PATIENT AND METHODS: Non-metastatic cancers diagnosed from 2000-2010 in the UK Anglian Cancer network stratified by age and risk group were analysed [n = 10,365]. Radiotherapy [RT] and prostatectomy [RP] cancer specific survival [CSS] were further compared [n = 4755].

RESULTS: Over the decade we observed a fall in uptake of primary androgen deprivation therapy but a rise in conservative management [CM] and radical therapy [p< 0.0001]. CM in particular has become the primary management for low-risk disease by the decade end [p< 0.0001]. In high-risk disease however both RP and RT uptake increased significantly but in an age dependent manner [p< 0.0001]. Principally, increased RP in younger men and increased RT in men ≥ 70y. In multivariate analysis of radically treated men both high-risk disease [HR 8.0 [2.9-22.2], p< 0.0001] and use of RT [HR 1.9 [1.0-3.3], p = 0.024] were significant predictors of a poorer CSM. In age-stratified analysis however, the trend to benefit of RP over RT was seen only in younger men [≤ 60 years] with high-risk disease [p = 0.07]. The numbers needed to treat by RP instead of RT to save one cancer death was 19 for this group but 67 for the overall cohort.

CONCLUSION: This study has identified significant shifts in non-metastatic prostate cancer management over the last decade. Low-risk disease is now primarily managed by CM while high-risk disease is increasingly treated radically. Treatment of high-risk younger men by RP is supported by evidence of better CSM but this benefit is not evident in older men.

Written by:
Greenberg DC, Lophatananon A, Wright KA, Muir KR, Gnanapragasam VJ.   Are you the author?
Public Health England, National Cancer Registration Service [Eastern Office], Cambridge, United Kingdom; Division of Health Sciences, Warwick Medical School, University of Warwick, Warwick, United Kingdom; Institute of Population Health, University of Manchester, Manchester, United Kingdom; Academic Urology Group, Department of Surgery & Oncology, University of Cambridge, Cambridge, United Kingdom; Translational Prostate Cancer Group, Hutchison/MRC Research centre, University of Cambridge, Cambridge, United Kingdom.

Reference: PLoS One. 2015 Mar 5;10(3):e0119494.
doi: 10.1371/journal.pone.0119494

 
PubMed Abstract
PMID: 25742020

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