title: Cancer-specific and other-cause mortality after radical prostatectomy versus observation in patients with prostate cancer: competing-risks analysis of a large North American population-based cohort.
abstract: BACKGROUND
  Initial treatment options for low-risk clinically localized prostate cancer (PCa) include radical prostatectomy (RP) or observation.
  
  
  OBJECTIVE
  To examine cancer-specific mortality (CSM) after accounting for other-cause mortality (OCM) in PCa patients treated with either RP or observation.
  
  
  METHODS
  Using the Surveillance Epidemiology and End Results Medicare-linked database, a total of 44 694 patients ≥65 yr with localized (T1/2) PCa were identified (1992-2005).
  
  
  METHODS
  RP and observation.
  
  
  METHODS
  Propensity-score matching was used to adjust for potential selection biases associated with treatment type. The matched cohort was randomly divided into the development and validation sets. Competing-risks regression models were fitted and a competing-risks nomogram was developed and externally validated.
  
  
  CONCLUSIONS
  Overall, 22,244 (49.8%) patients were treated with RP versus 22450 (50.2%) with observation. Propensity score-matched analyses derived 11,669 matched pairs. In the development cohort, the 10-yr CSM rate was 2.8% (2.3-3.5%) for RP versus 5.8% (5.0-6.6%) for observation (absolute risk reduction: 3.0%; relative risk reduction: 0.5%; p<0.001). In multivariable analyses, the CSM hazard ratio for RP was 0.48 (0.38-0.59) relative to observation (p<0.001). The competing-risks nomogram discrimination was 73% and 69% for prediction of CSM and OCM, respectively, in external validation. The nature of observational data may have introduced a selection bias.
  
  
  CONCLUSIONS
  On average RP reduces the risk of CSM by half in patients aged ≥65 yr, relative to observation. The individualized protective effect of RP relative to observation may be quantified with our nomogram.
authors: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Quebec, Canada.
authors: Firas
authors: F
authors: Abdollah
authors: Maxine
authors: M
authors: Sun
authors: Jan
authors: J
authors: Schmitges
authors: Zhe
authors: Z
authors: Tian
authors: Claudio
authors: C
authors: Jeldres
authors: Alberto
authors: A
authors: Briganti
authors: Shahrohk F
authors: SF
authors: Shariat
authors: Paul
authors: P
authors: Perrotte
authors: Francesco
authors: F
authors: Montorsi
authors: Pierre I
authors: PI
authors: Karakiewicz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003661:Decision Support Techniques; D006801:Humans; D016015:Logistic Models; D008297:Male; D049451:Nomograms; D009656:North America / Q000453:epidemiology; D018579:Patient Selection; D057216:Propensity Score; D011468:Prostatectomy / Q000401:mortality*; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D018570:Risk Assessment; D012307:Risk Factors; D018426:SEER Program; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D057832:Watchful Waiting