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    World journal of urology. 2018 May 2. doi: 10.1007/s00345-018-2310-y. pii: 10.1007/s00345-018-2310-y
    Survival after radical prostatectomy or radiotherapy for locally advanced (cT3) prostate cancer.
    Bandini M1,  Marchioni M2,  Preisser F3,  Zaffuto E4,  Tian Z5,  Tilki D6,  Montorsi F7,  Shariat SF8,  Saad F9,  Briganti A10,  Karakiewicz PI11
    Author information
    1Division of Oncology/Unit of Urology URI, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, MI, Italy. marco.bandini.zoli@gmail.com.
    2Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada.
    3Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada.
    4Division of Oncology/Unit of Urology URI, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, MI, Italy.
    5Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada.
    6Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
    7Division of Oncology/Unit of Urology URI, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, MI, Italy.
    8Department of Urology, Medical University of Vienna, Vienna, Austria.
    9Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada.
    10Division of Oncology/Unit of Urology URI, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, MI, Italy.
    11Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada.
    Abstract

    PURPOSE: No prospective data examined the effect of radical prostatectomy (RP) vs. external beam radiotherapy (EBRT) in locally advanced prostate cancer (PCa). We aimed to compare survival outcomes of RP and EBRT in patients harboring cT3N0-1 PCa.

    METHODS: Within the SEER database (2004-2014), we identified 5500 cT3N0-1 PCa patients. Cumulative incidence plots and competing-risks regression models (CRRs) tested cancer-specific mortality (CSM) and other cause of mortality (OCM) according to treatment type. The multivariable relationship between baseline prostate-specific antigen (PSA) values and 10-year CSM after either RP or EBRT was graphically depicted using the LOESS smoothing method. Sensitivity analyses were performed in cT3N0-only patients, after OCM propensity score matching, and through landmark analyses.

    RESULTS: Ten-year CSM and OCM rates were significantly higher after EBRT (15.8 and 28.2%) than RP (8.1 and 10.4%) (all p < 0.0001). In multivariable CRRs, RP yielded lower CSM [hazard ratio (HR): 0.64] than EBRT. Significantly lower 10-year CSM rate was recorded after RP vs. EBRT through the entire range of baseline PSA values. The same results were recorded in cT3N0 subgroup, as well as after OCM propensity score matching. Finally, landmark analyses at 6, 12, 24, and 36 months rejected the effect of favorable survival bias after RP.

    CONCLUSIONS: CSM was significantly lower after RP than EBRT in cT3N0-1 PCa. A lower CSM was recorded throughout the entire range of baseline PSA and even in cT3N0 subgroup, as well as after OCM propensity score matching and landmark analyses.


    KEYWORDS: External beam radiotherapy, Locally advanced disease, Prostate cancer, Radical prostatectomy, SEER program

    Publikations ID: 29717358
    Quelle: öffnen
     
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