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Annals of Surgical Oncology

, Volume 21, Issue 12, pp 4026–4033 | Cite as

A Competing Risk Analysis of Cancer-Specific Mortality of Initial Treatment with Radical Prostatectomy versus Radiation Therapy in Clinically Localized High-Risk Prostate Cancer

  • Joo Yong Lee
  • Kang Su Cho
  • Jong Kyou Kwon
  • Seong Uk Jeh
  • Ho Won Kang
  • Richilda Red Diaz
  • Won Sik Ham
  • Woong Sub Koom
  • Ki Chang Keum
  • Young Deuk ChoiEmail author
Urologic Oncology

Abstract

Background

There is no consensus on the optimal treatment for localized high-risk prostate cancer (PC), and much debate exists regarding the ideal treatment approach. For these reasons, we evaluated the competing risks of PC-specific mortality after initial therapy with radical prostatectomy (RP) versus radiotherapy (RT) in men with clinically localized high-risk PC.

Methods

We reviewed patients treated with RP and RT combined with androgen-deprivation therapy between 1990 and 2009. High-risk PC is defined as clinical stage ≥T3a, serum prostate-specific antigen (PSA) >20 ng/mL, or a biopsy Gleason sum of 8–10 according to National Comprehensive Cancer Network guidelines. Competing risk analysis was conducted to assess the association of RP (n = 251) or RT (n = 125) with cancer-specific mortality (CSM). Thereafter, secondary analysis with propensity score matching was conducted to further elucidate patient characteristics, with optimal matching of 0.25 times the standard deviation of propensity scores.

Results

With an overall median follow-up of 76 months, 35 (9.3 %) men with high-risk PC died due to PC (23 in the RT group and 12 in the RP group). The 5-year estimates of cancer-specific survival rate for men treated with RP and RT were 96.5 % (95 % confidence interval [CI] 94.2–98.9) and 88.3 % (95 % CI 82.8–94.3), respectively. Cumulative incidence estimates for CSM were statistically increased amongst men treated with RT (p = 0.002). Propensity score matching extracted 168 men with high-risk PC from the total patient cohort. Cumulative incidence estimates for CSM were statistically different amongst men treated with RT (p < 0.001).

Conclusions

Initial treatment with RP versus RT was associated with a decreased risk of CSM in men with clinically localized high-risk PC.

Keywords

Prostate Cancer Propensity Score Radical Prostatectomy National Comprehensive Cancer Network National Comprehensive Cancer Network 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

This study was supported by a grant from the Korean Foundation for Cancer Research (CB-2011-04-02), Republic of Korea.

Disclosure

Joo Yong Lee, Kang Su Cho, Jong Kyou Kwon, Seong Uk Jeh, Ho Won Kang, Richilda Red Diaz, Won Sik Ham, Woong Sub Koom, Ki Chang Keum, and Young Deuk Choi do not have any conflicts of interest.

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Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Joo Yong Lee
    • 1
  • Kang Su Cho
    • 2
  • Jong Kyou Kwon
    • 1
  • Seong Uk Jeh
    • 1
  • Ho Won Kang
    • 1
  • Richilda Red Diaz
    • 1
  • Won Sik Ham
    • 1
  • Woong Sub Koom
    • 3
  • Ki Chang Keum
    • 3
  • Young Deuk Choi
    • 1
    • 4
    Email author
  1. 1.Department of Urology, Severance Hospital, Urological Science InstituteYonsei University College of MedicineSeoulKorea
  2. 2.Department of Urology, Gangnam Severance Hospital, Urological Science InstituteYonsei University College of MedicineSeoulKorea
  3. 3.Department of Radiation Oncology, Severance HospitalYonsei University College of MedicineSeoulKorea
  4. 4.Robot and Minimal Invasive Surgery Center, Severance HospitalYonsei University College of MedicineSeoulKorea

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