title: Comparative effectiveness of radical prostatectomy and radiotherapy in prostate cancer: observational study of mortality outcomes.
abstract: OBJECTIVE
  To compare the survival outcomes of patients treated with surgery or radiotherapy for prostate cancer.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  Sweden, 1996-2010.
  
  
  METHODS
  34,515 men primarily treated for prostate cancer with surgery (n=21,533) or radiotherapy (n=12,982). Patients were categorised by risk group (low, intermediate, high, and metastatic), age, and Charlson comorbidity score.
  
  
  METHODS
  Cumulative incidence of mortality from prostate cancer and other causes. Competing risks regression hazard ratios for radiotherapy versus surgery were computed without adjustment and after propensity score and traditional (multivariable) adjustments, as well as after propensity score matching. Several sensitivity analyses were performed.
  
  
  RESULTS
  Prostate cancer mortality became a larger proportion of overall mortality as risk group increased for both the surgery and the radiotherapy cohorts. Among patients with non-metastatic prostate cancer the adjusted subdistribution hazard ratio for prostate cancer mortality favoured surgery (1.76, 95% confidence interval 1.49 to 2.08, for radiotherapy v prostatectomy), whereas there was no discernible difference in treatment effect among men with metastatic disease. Subgroup analyses indicated more clear benefits of surgery among younger and fitter men with intermediate and high risk disease. Sensitivity analyses confirmed the main findings.
  
  
  CONCLUSIONS
  This large observational study with follow-up to 15 years suggests that for most men with non-metastatic prostate cancer, surgery leads to better survival than does radiotherapy. Younger men and those with less comorbidity who have intermediate or high risk localised prostate cancer might have a greater benefit from surgery.
authors.affiliation: Department of Urology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Prasanna
authors.initials: P
authors.lastname: Sooriakumaran
authors.forename: Tommy
authors.initials: T
authors.lastname: Nyberg
authors.forename: Olof
authors.initials: O
authors.lastname: Akre
authors.forename: Leif
authors.initials: L
authors.lastname: Haendler
authors.forename: Inge
authors.initials: I
authors.lastname: Heus
authors.forename: Mats
authors.initials: M
authors.lastname: Olsson
authors.forename: Stefan
authors.initials: S
authors.lastname: Carlsson
authors.forename: Monique J
authors.initials: MJ
authors.lastname: Roobol
authors.forename: Gunnar
authors.initials: G
authors.lastname: Steineck
authors.forename: Peter
authors.initials: P
authors.lastname: Wiklund
mesh_terms: D000368:Aged; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome