title: Population-based comparative effectiveness of salvage radical prostatectomy vs cryotherapy.
abstract: OBJECTIVE
  To characterize population-based practice patterns, disease-specific and overall mortality, and cost associated with salvage cryotherapy (SCT) vs salvage radical prostatectomy (SRP).
  
  
  METHODS
  We retrospectively identified 440 men who failed primary radiation therapy and subsequently underwent SCT (n = 341, 77.5%) or SRP (n = 99, 22.5%) between 1992 and 2009 from Surveillance, Epidemiology, and End Results-Medicare linked data. Propensity score analyses were used to compare overall and prostate cancer-specific mortality and associated Medicare expenditures for SRP vs SCT.
  
  
  RESULTS
  Men undergoing SCT were more likely to be white (P <.001), less likely to be high school graduates (P = .008), and experienced shorter median time from diagnosis to salvage therapy (44.1 vs 60.1, P <.001) and from primary radiotherapy to salvage therapy (38.7 vs 55.8 months, P <.001). In adjusted analyses, overall mortality was higher (21.6 vs 6.1 deaths/100 person years, P <.001) for SRP vs SCT. There was a trend for higher prostate cancer-specific death rates with SRP vs SCT (6.5 vs 1.4 deaths/100 person years, P = .061). Medicare expenditures for SRP vs SCT were more than 2-fold higher ($19,543 vs $8,088, P <.001).
  
  
  CONCLUSIONS
  SRP vs SCT is associated with higher overall mortality and greater health care expenditures. However, longer follow-up is needed to assess long-term functional outcomes and cancer control.
authors.affiliation: Division of Urology, Brigham and Women's Hospital, Boston, MA.
authors.forename: David F
authors.initials: DF
authors.lastname: Friedlander
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA.
authors.forename: Xiangmei
authors.initials: X
authors.lastname: Gu
authors.affiliation: Department of Urology, Medical University of South Carolina, Charleston, SC; Section of Urology, Ralph A. Johnson VA Medical Center, Charleston, SC.
authors.forename: Sandip M
authors.initials: SM
authors.lastname: Prasad
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA.
authors.forename: Stuart R
authors.initials: SR
authors.lastname: Lipsitz
authors.affiliation: Department of Radiation Oncology, Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute, Boston, MA.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Nguyen
authors.affiliation: Division of Urologic Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA.
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
authors.affiliation: Department of Public Health, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.affiliation: Department of Urology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA. Electronic address: jchu@mednet.ucla.edu.
authors.forename: Jim C
authors.initials: JC
authors.lastname: Hu
mesh_terms: D000368:Aged; D017679:Cryotherapy / Q000191:economics; D006801:Humans; D008297:Male; D011468:Prostatectomy / Q000191:economics; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000532:radiotherapy / Q000601:surgery*; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000191:economics / Q000379:methods*; D015996:Survival Rate; D013997:Time Factors; D017211:Treatment Failure; D014481:United States / Q000453:epidemiology