title: Survival after radical prostatectomy and radiotherapy for prostate cancer: a population-based study.
abstract: 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.
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montréal Health Centre (CHUM), Montréal, Que., and the.
authors.forename: Claudio
authors.initials: C
authors.lastname: Jeldres
authors.forename: Nazareno
authors.initials: N
authors.lastname: Suardi
authors.forename: Paul
authors.initials: P
authors.lastname: Perrotte
authors.forename: Umberto
authors.initials: U
authors.lastname: Capitanio
authors.forename: Jochen
authors.initials: J
authors.lastname: Walz
authors.forename: Georg C
authors.initials: GC
authors.lastname: Hutterer
authors.forename: Fred
authors.initials: F
authors.lastname: Saad
authors.forename: Luc
authors.initials: L
authors.lastname: Valiquette
authors.forename: Markus
authors.initials: M
authors.lastname: Graefen
authors.forename: Hugues
authors.initials: H
authors.lastname: Widmer
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz