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The comparison of the survival outcome between robotic-assisted radical prostatectomy and radiation therapy for localized prostate cancer in men over 70 years: Korean Nationwide Observational Study

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Abstract

This study aimed to investigate the survival after robotic-assisted radical prostatectomy (RARP) in comparison with radiation therapy (RT) in elderly patients (≥ 70 years) with non-metastatic prostate cancer (PCa), given the contemporary Korean life span of 80 years. From the National Health Insurance Sharing Service data, men aged ≥ 70 years diagnosed with PCa from 2006 through 2016 undergoing RARP or RT without systemic chemotherapy or prolonged androgen deprivation therapy (ADT) were identified, then the mortality was compared after adjusting host factors. Data revealed 13,952 patients with RARP (N = 7535) or RT (N = 6417). Patients who underwent RARP were younger (73.81 ± 3.58 vs. 75.05 ± 3.83 years) and had a higher income. While the majority of the RARP group (94.1%) received no additional therapy, 57.4% of the RT group combined ADT. The adjusted mortality rate for total patients was lower in the RARP group (HR = 0.767, 95% CI 0.072–0.818, p < 0.0001). From the age of 75 years, more patients underwent RT (n = 3239) than RARP (n = 2478). When dividing patients by this age cut-off, the adjusted mortality for the younger patient (70–74 years) was lower in the RARP group than the RT group (HR = 0.580, p < 0.0001). In contrast, the adjusted mortality rate for men older than 75 years was similar (HR = 0.98, 95% CI 0.897–1.07, p = 0.649). This study demonstrates that even the patient over 75 years old who could afford to undergo robotic-assisted radical prostatectomy for non-metastatic PCa had a similar survival in comparison with RT, which had long been a standard of care for this particular age group.

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Abbreviations

ADT:

Androgen deprivation therapy

RARP:

Robotic-assisted radical prostatectomy

RT:

Radiation therapy

References

  1. Jenjitranant P, Touijer KA (2019) Role of surgery in oligometastatic prostate cancer. Prostate Int 7(4):125–130

    Article  Google Scholar 

  2. Matulay JT, DeCastro GJ (2017) Radical prostatectomy for high-risk localized or node-positive prostate cancer: removing the primary. Curr Urol Rep 18(7):53

    Article  Google Scholar 

  3. Sanda MG, Cadeddu JA, Kirkby E, Chen RC, Crispino T, Fontanarosa J et al (2018) Clinically localized prostate cancer: AUA/ASTRO/SUO Guideline. Part I: risk stratification, shared decision making, and care options. J Urol 199(3):683–690

    Article  Google Scholar 

  4. Mottet N, Bellmunt J, Bolla M, Briers E, Cumberbatch MG, De Santis M et al (2017) EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol 71(4):618–629

    Article  Google Scholar 

  5. Hamdy FC, Donovan JL, Lane JA, Mason M, Metcalfe C, Holding P et al (2016) 10-Year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer. N Engl J Med 375(15):1415–1424

    Article  Google Scholar 

  6. Serrell EC, Pitts D, Hayn M, Beaule L, Hansen MH, Sammon JD (2018) Review of the comparative effectiveness of radical prostatectomy, radiation therapy, or expectant management of localized prostate cancer in registry data. Urol Oncol 36(4):183–192

    Article  Google Scholar 

  7. Wallis CJD, Saskin R, Choo R, Herschorn S, Kodama RT, Satkunasivam R et al (2016) Surgery versus radiotherapy for clinically-localized prostate cancer: a systematic review and meta-analysis. Eur Urol 70(1):21–30

    Article  Google Scholar 

  8. Sheng W, Kirschner-Hermanns R, Zhang H (2019) Elderly patients aged ≥ 75 years with locally advanced prostate cancer may benefit from local treatment: a population-based propensity score-adjusted analysis. World J Urol 37(2):317–325

    Article  Google Scholar 

  9. NCCN guidelines Prostate cancer, version 4. (2019). https://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf. Accessed 11 Nov 2019

  10. Korean Statistical Information Service, 2019 (for 2017). https://countryeconomy.com/demography/life-expectancy/south-korea. Accessed 11 Nov 2019

  11. Shao YH, Kim S, Moore DF, Shih W, Lin Y, Stein M et al (2014) Cancer-specific survival after metastasis following primary radical prostatectomy compared with radiation therapy in prostate cancer patients: results of a population-based, propensity score-matched analysis. Eur Urol 65(4):693–700

    Article  Google Scholar 

  12. Ito K, Oki R, Sekine Y, Arai S, Miyazawa Y, Shibata Y et al (2019) Screening for prostate cancer: history, evidence, controversies and future perspectives toward individualized screening. Int J Urol 26(10):956–970

    Article  Google Scholar 

  13. National Cancer Information Center, 2019 (for 2017). https://www.cancer.go.kr/. Accessed 11 Nov 2019

  14. Oki R, Ito K, Suzuki R, Fujizuka Y, Arai S, Miyazawa Y et al (2018) Long-term longitudinal changes in baseline PSA distribution and estimated prevalence of prostate cancer in male Japanese participants of population-based PSA screening. Int J Cancer 143(7):1611–1619

    Article  CAS  Google Scholar 

  15. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D (2011) Global cancer statistics. CA Cancer J Clin 61(2):69–90

    Article  Google Scholar 

  16. Soos G, Tsakiris I, Szanto J, Turzo C, Haas PG, Dezso B (2005) The prevalence of prostate carcinoma and its precursor in Hungary: an autopsy study. Eur Urol 48(5):739–744

    Article  Google Scholar 

  17. Rice KR, Colombo ML, Wingate J, Chen Y, Cullen J, McLeod DG et al (2013) Low risk prostate cancer in men ≥ 70 years old: to treat or not to treat. Urol Oncol 31(6):755–760

    Article  Google Scholar 

  18. Sun L, Caire AA, Robertson CN, George DJ, Polascik TJ, Maloney KE et al (2009) Men older than 70 years have higher risk prostate cancer and poorer survival in the early and late prostate specific antigen eras. J Urol 182(5):2242–2248

    Article  CAS  Google Scholar 

  19. Brassell SA, Rice KR, Parker PM, Chen Y, Farrell JS, Cullen J et al (2011) Prostate cancer in men 70 years old or older, indolent or aggressive: clinicopathological analysis and outcomes. J Urol 185(1):132–137

    Article  Google Scholar 

  20. Dahm P, Silverstein AD, Weizer AZ, Crisci A, Vieweg J, Paulson DF (2003) When to diagnose and how to treat prostate cancer in the "not too fit" elderly. Crit Rev Oncol Hematol 48(2):123–131

    Article  Google Scholar 

  21. Delongchamps NB, Wang CY, Chandan V, Jones RF, Threatte G, Jumbelic M et al (2009) Pathological characteristics of prostate cancer in elderly men. J Urol 182(3):927–930

    Article  Google Scholar 

  22. Abdollah F, Sun M, Thuret R, Jeldres C, Tian Z, Briganti A et al (2011) A competing-risks analysis of survival after alternative treatment modalities for prostate cancer patients: 1988–2006. Eur Urol 59(1):88–95

    Article  Google Scholar 

  23. Sooriakumaran P, Nyberg T, Akre O, Haendler L, Heus I, Olsson M et al (2014) Comparative effectiveness of radical prostatectomy and radiotherapy in prostate cancer: observational study of mortality outcomes. BMJ 348:g1502

    Article  Google Scholar 

  24. Bosco C, Bosnyak Z, Malmberg A, Adolfsson J, Keating NL, Van Hemelrijck M (2015) Quantifying observational evidence for risk of fatal and nonfatal cardiovascular disease following androgen deprivation therapy for prostate cancer: a meta-analysis. Eur Urol 68(3):386–396

    Article  Google Scholar 

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Acknowledgements

This work was supported by a Grant from the Chunma Medical Research Foundation, Korea, 2020.

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  1. Department of Urology, College of Medicine, Yeungnam University, 317-1 Daemyung-dong, Nam-gu, Daegu, 705-035, Republic of Korea

    Young Hwii Ko

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Ko, Y.H. The comparison of the survival outcome between robotic-assisted radical prostatectomy and radiation therapy for localized prostate cancer in men over 70 years: Korean Nationwide Observational Study. J Robotic Surg 15, 585–592 (2021). https://doi.org/10.1007/s11701-020-01144-w

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  • DOI: https://doi.org/10.1007/s11701-020-01144-w

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