Survival after radical prostatectomy and radiotherapy for prostate cancer: a population-based study.
OBJECTIVE
Based on the natural history of localized prostate cancer, the life expectancy (LE) of men treated with either radical prostatectomy (RP) or definitive external-beam radiotherapy (EBRT) should exceed 10 years. To test this hypothesis, we examined overall survival rates after RP or EBRT in a contemporary population-based cohort.


METHODS
Within a population-based cohort we assessed crude survival in 17 570 men diagnosed with prostate cancer who were either treated with RP (n = 9678) or definitive EBRT (n = 7892) between 1989 and 2000. Age and Charlson Comorbidity Index (CCI) score at treatment represented covariates. In order to control for prostate cancer-related mortality, we repeated analyses for 9131 men who did not receive any secondary treatment for prostate cancer.


RESULTS
In the entire cohort, the actuarial 10-year survival probability after RP was 75.3%, versus 36.7% after EBRT (p < 0.001). In those who did not receive any secondary treatment, the actuarial 10-year survival probability after RP was 81.1%, versus 30.4% after EBRT (p < 0.001). In multivariate Cox regression models, EBRT was associated with a 2.8-fold (p < 0.001) and 3.9-fold (p < 0.001) higher risk of mortality in the entire cohort and in the cohort without secondary treatment, respectively. Increased CCI score and increased age were also associated with a higher risk of mortality (p < 0.001).


CONCLUSIONS
Some men treated with EBRT and, to a lesser extent, those treated with RP may have insufficient LE to warrant therapy with curative intent. More stringent selection criteria are necessary to avoid overtreatment.
Jeldres
Claudio
C
Cancer Prognostics and Health Outcomes Unit, University of Montréal Health Centre (CHUM), Montréal, Que., and the.
Suardi
Nazareno
N
Perrotte
Paul
P
Capitanio
Umberto
U
Walz
Jochen
J
Hutterer
Georg C
GC
Saad
Fred
F
Valiquette
Luc
L
Graefen
Markus
M
Widmer
Hugues
H
Karakiewicz
Pierre I
PI