Comparative effectiveness of radical prostatectomy with adjuvant radiotherapy versus radiotherapy plus androgen deprivation therapy for men with advanced prostate cancer Journal Article


Authors: Jang, T. L.; Patel, N.; Faiena, I.; Radadia, K. D.; Moore, D. F.; Elsamra, S. E.; Singer, E. A.; Stein, M. N.; Eastham, J. A.; Scardino, P. T.; Lin, Y.; Kim, I. Y.; Lu-Yao, G. L.
Article Title: Comparative effectiveness of radical prostatectomy with adjuvant radiotherapy versus radiotherapy plus androgen deprivation therapy for men with advanced prostate cancer
Abstract: Background:: Men with locally advanced prostate cancer (LAPCa) or regionally advanced prostate cancer (RAPCa) are at high risk for death from their disease. Clinical guidelines support multimodal approaches, which include radical prostatectomy (RP) followed by radiotherapy (XRT) and XRT plus androgen deprivation therapy (ADT). However, there are limited data comparing these substantially different treatment approaches. Using Surveillance, Epidemiology, and End Results (SEER)–Medicare data, this study compared survival outcomes and adverse effects associated with RP plus XRT versus XRT plus ADT in these men. Methods:: SEER-Medicare data were queried for men with cT3-T4N0M0 (LAPCa) or cT3-T4N1M0 (RAPCa) prostate cancer. Propensity score methods were used to balance cohort characteristics between the treatment arms. Survival analyses were analyzed with the Kaplan-Meier method and Cox proportional hazards models. Results:: From 1992 to 2009, 13,856 men (≥65 years old) were diagnosed with LAPCa or RAPCa: 6.1% received RP plus XRT, and 23.6% received XRT plus ADT. At a median follow-up of 14.6 years, there were 2189 deaths in the cohort, of which 702 were secondary to prostate cancer. Regardless of the tumor stage or the Gleason score, the adjusted 10-year prostate cancer–specific survival and 10-year overall survival favored men who underwent RP plus XRT over men who underwent XRT plus ADT. However, RP plus XRT versus XRT plus ADT was associated with higher rates of erectile dysfunction (28% vs 20%; P =.0212) and urinary incontinence (49% vs 19%; P <.001). Conclusions:: Men with LAPCa or RAPCa treated initially with RP plus XRT had a lower risk of prostate cancer–specific death and improved overall survival in comparison with those men treated with XRT plus ADT, but they experienced higher rates of erectile dysfunction and urinary incontinence. © 2018 American Cancer Society
Keywords: survival; combined modality therapy; radiation; prostate cancer; surgery; outcomes; hormone therapy; comparative effectiveness; population and observational studies
Journal Title: Cancer
Volume: 124
Issue: 20
ISSN: 0008-543X
Publisher: Wiley Blackwell  
Date Published: 2018-10-15
Start Page: 4010
End Page: 4022
Language: English
DOI: 10.1002/cncr.31726
PUBMED: 30252932
PROVIDER: scopus
PMCID: PMC6234085
DOI/URL:
Notes: Article -- Export Date: 3 December 2018 -- Source: Scopus
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MSK Authors
  1. Peter T Scardino
    613 Scardino
  2. James Eastham
    420 Eastham