title: Comparison of mortality outcomes after radical prostatectomy versus radiotherapy in patients with localized prostate cancer: a population-based analysis.
abstract: OBJECTIVE
  To compare the mortality outcomes of radical prostatectomy and radiotherapy as treatment modalities for patients with localized prostate cancer.
  
  
  METHODS
  Our cohort consisted of 68 665 patients with localized prostate cancer, treated with radical prostatectomy or radiotherapy, between 1992 and 2005. Propensity-score matching was used to minimize potential bias related to treatment assignment. Competing-risks analyses tested the effect of treatment type on cancer-specific mortality, after accounting for other-cause mortality. All analyses were stratified according to prostate cancer risk groups, baseline Charlson Comorbidity Index and age.
  
  
  RESULTS
  For patients treated with radical prostatectomy versus radiotherapy, the 10-year cancer-specific mortality rates were 1.4 versus 3.9% in low-intermediate risk prostate cancer and 6.8 versus 11.5% in high-risk prostate cancer, respectively. Rates were 2.4 versus 5.9% in patients with Charlson Comorbidity Index of 0, 2.4 versus 5.1% in patients with Charlson Comorbidity Index of 1, and 2.9 versus 5.2% in patients with Charlson Comorbidity Index of ≥2. Rates were 2.1 versus 5.0% in patients aged 65-69 years, 2.8 versus 5.5% in patients aged 70-74 years, and 2.9 versus 7.6% in patients aged 75-80 years (all P < 0.001). At multivariable analyses, radiotherapy was associated with less favorable cancer-specific mortality in all categories (all P < 0.001).
  
  
  CONCLUSIONS
  Patients treated with radical prostatectomy fare substantially better than those treated with radiotherapy. Patients with high-risk prostate cancer benefit the most from radical prostatectomy. Conversely, the lowest benefit was observed in patients with low-intermediate risk prostate cancer and/or multiple comorbidities. An intermediate benefit was observed in the other examined categories.
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Quebec, Canada. firas.abdollah@gmail.com
authors.forename: Firas
authors.initials: F
authors.lastname: Abdollah
authors.forename: Jan
authors.initials: J
authors.lastname: Schmitges
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.forename: Claudio
authors.initials: C
authors.lastname: Jeldres
authors.forename: Zhe
authors.initials: Z
authors.lastname: Tian
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Paul
authors.initials: P
authors.lastname: Perrotte
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D006801:Humans; D008297:Male; D057216:Propensity Score; D011468:Prostatectomy / Q000401:mortality*; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000628:therapy*; D011878:Radiotherapy / Q000401:mortality*; D018570:Risk Assessment; D018426:SEER Program; D014481:United States