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Survival after radical prostatectomy vs. radiation therapy in ductal carcinoma of the prostate

  • Urology - Original Paper
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Abstract

Aim

To compare cancer-specific mortality (CSM) rates between radical prostatectomy (RP) vs. external beam radiotherapy (RT) in patients with ductal carcinoma (DC) of the prostate.

Materials and methods

Within the Surveillance, Epidemiology, and End Results (SEER) database (2004–2016), we identified 369 DC patients, of whom 303 (82%) vs. 66 (18%) were treated with RP vs. RT, respectively. Kaplan–Meier plots and uni- and stepwise multivariate Cox regression models addressed CSM in the unmatched population. After propensity score matching (PSM) and inverse probability of treatment weighting (IPTW), Kaplan–Meier curve and Cox regression models tested the effect of RP vs RT on CSM.

Results

Overall, RT patients were older, harbored higher PSA values, higher clinical T and higher Gleason grade groups. 5-year CSM rates were respectively 4.2 vs. 10% for RP vs. RT (HR 0.40, 95% CI 0.16–0.99, p = 0.048, favoring RP). At step-by-step multivariate Cox regression, after adding possible confounders, the central tendency of the HR for RP vs. RT approached 1. PSM resulted into 124 vs. 53 patients treated respectively with RP vs. RT. After PSM, as well as after IPTW, the protective effect of RP was no longer present (HR 1.16, 95% CI 0.23–5.73, p = 0.9 and 0.97, 95% CI 0.35–2.66, p = 0.9, respectively).

Conclusions

Although CSM rate of ductal carcinoma RP patients is lower of that of RT patients, this apparent benefit disappears after statistical adjustment for population differences.

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Author information

Author notes

  1. Francesco Chierigo and Marco Borghesi contributed equally and should be considered co-first authors.

Authors and Affiliations

  1. Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy

    Francesco Chierigo, Marco Borghesi, Guglielmo Mantica, Nazareno Suardi & Carlo Terrone

  2. Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada

    Francesco Chierigo, Christoph Würnschimmel, Rocco Simone Flammia, Benedikt Horlemann, Gabriele Sorce, Benedikt Höh, Zhe Tian, Fred Saad & Pierre I. Karakiewicz

  3. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany

    Christoph Würnschimmel & Markus Graefen

  4. Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza Rome University, Rome, Italy

    Rocco Simone Flammia & Michele Gallucci

  5. Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Gabriele Sorce, Alberto Briganti & Francesco Montorsi

  6. Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany

    Benedikt Höh & Felix K. H. Chun

  7. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria

    Shahrokh F. Shariat

  8. Departments of Urology, Weill Cornell Medical College, New York, NY, USA

    Shahrokh F. Shariat

  9. Department of Urology, University of Texas Southwestern, Dallas, TX, USA

    Shahrokh F. Shariat

  10. Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic

    Shahrokh F. Shariat

  11. Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia

    Shahrokh F. Shariat

  12. Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan

    Shahrokh F. Shariat

  13. Department of Urology, Policlinico San Martino Hospital, University of Genova, Largo Rosanna Benzi 10, 16132, Genova, Italy

    Francesco Chierigo

Authors
  1. Francesco Chierigo
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  2. Marco Borghesi
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  3. Christoph Würnschimmel
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  4. Rocco Simone Flammia
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  5. Benedikt Horlemann
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  6. Gabriele Sorce
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  7. Benedikt Höh
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  8. Zhe Tian
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  9. Fred Saad
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  11. Michele Gallucci
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  12. Alberto Briganti
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  13. Francesco Montorsi
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  14. Felix K. H. Chun
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  15. Shahrokh F. Shariat
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  16. Guglielmo Mantica
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  17. Nazareno Suardi
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  18. Carlo Terrone
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  19. Pierre I. Karakiewicz
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Contributions

FC – protocol/project development, data collection or management, data analysis, manuscript writing/editing; MB—protocol/project development, data collection or management, data analysis, manuscript writing/editing; CW—protocol/project development, manuscript writing/editing; RSF—protocol/project development, manuscript writing/editing; BH—protocol/project development, manuscript writing/editing; GS—protocol/project development, manuscript writing/editing; ZT – data collection or management, data analysis; FS—manuscript writing/editing; MG—manuscript writing/editing; MG—manuscript writing/editing; Alberto Briganti—manuscript writing/editing; FM—manuscript writing/editing; FKHC—manuscript writing/editing; SFS—mwriting/editing; GM—manuscript writing/editing; NS—manuscript writing/editing; CT—manuscript writing/editing; PIK—protocol/project development, manuscript writing/editing.

Corresponding author

Correspondence to Francesco Chierigo.

Ethics declarations

Conflict of interest

The research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Human and animal rights

All analyses and their reporting followed the Surveillance, Epidemiology, and End Results database (SEER) reporting guidelines. Due to the anonymously coded design of the SEER database, study-specific Institutional Review Board (IRB) ethics approval was not required.

Informed consent

Not applicable to the SEER database.

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Chierigo, F., Borghesi, M., Würnschimmel, C. et al. Survival after radical prostatectomy vs. radiation therapy in ductal carcinoma of the prostate. Int Urol Nephrol 54, 89–95 (2022). https://doi.org/10.1007/s11255-021-03070-8

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  • DOI: https://doi.org/10.1007/s11255-021-03070-8

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