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Survival after radical prostatectomy or radiotherapy for locally advanced (cT3) prostate cancer

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Abstract

Purpose

No prospective data examined the effect of radical prostatectomy (RP) vs. external beam radiotherapy (EBRT) in locally advanced prostate cancer (PCa). We aimed to compare survival outcomes of RP and EBRT in patients harboring cT3N0-1 PCa.

Methods

Within the SEER database (2004–2014), we identified 5500 cT3N0-1 PCa patients. Cumulative incidence plots and competing-risks regression models (CRRs) tested cancer-specific mortality (CSM) and other cause of mortality (OCM) according to treatment type. The multivariable relationship between baseline prostate-specific antigen (PSA) values and 10-year CSM after either RP or EBRT was graphically depicted using the LOESS smoothing method. Sensitivity analyses were performed in cT3N0-only patients, after OCM propensity score matching, and through landmark analyses.

Results

Ten-year CSM and OCM rates were significantly higher after EBRT (15.8 and 28.2%) than RP (8.1 and 10.4%) (all p < 0.0001). In multivariable CRRs, RP yielded lower CSM [hazard ratio (HR): 0.64] than EBRT. Significantly lower 10-year CSM rate was recorded after RP vs. EBRT through the entire range of baseline PSA values. The same results were recorded in cT3N0 subgroup, as well as after OCM propensity score matching. Finally, landmark analyses at 6, 12, 24, and 36 months rejected the effect of favorable survival bias after RP.

Conclusions

CSM was significantly lower after RP than EBRT in cT3N0-1 PCa. A lower CSM was recorded throughout the entire range of baseline PSA and even in cT3N0 subgroup, as well as after OCM propensity score matching and landmark analyses.

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Authors and Affiliations

  1. Division of Oncology/Unit of Urology URI, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, MI, Italy

    Marco Bandini, Emanuele Zaffuto, Francesco Montorsi & Alberto Briganti

  2. Vita-Salute San Raffaele University, Milan, Italy

    Marco Bandini, Emanuele Zaffuto, Francesco Montorsi & Alberto Briganti

  3. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada

    Marco Bandini, Michele Marchioni, Felix Preisser, Zhe Tian, Fred Saad & Pierre I. Karakiewicz

  4. Department of Urology, SS Annunziata Hospital, “G. D’Annunzio” University of Chieti, Chieti, Italy

    Michele Marchioni

  5. Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Felix Preisser & Derya Tilki

  6. Department of Urology, Medical University of Vienna, Vienna, Austria

    Shahrokh F. Shariat

Authors
  1. Marco Bandini
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  2. Michele Marchioni
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  3. Felix Preisser
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  4. Emanuele Zaffuto
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Contributions

MB: protocol/project development, data collection or management, data analysis, manuscript writing/editing. FP: data collection or management. MM: manuscript writing/editing. ZT: data analysis. EZ: manuscript writing/editing. DT: data analysis. FM: protocol/project development. SFS: data collection or management. AB: protocol/project development. FS: manuscript writing/editing. PIK: manuscript writing/editing, protocol/project development.

Corresponding author

Correspondence to Marco Bandini.

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Conflict of interest

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors have stated that they have no conflict of interest.

Electronic supplementary material

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345_2018_2310_MOESM1_ESM.tiff

Supplementary Figure 1. Graphical depiction of multivariable adjusted cancer specific mortality rate (LOESS) in 1,866 cT3N0-1 prostate cancer after other cause mortality propensity score matching according to treatment received: radical prostatectomy vs. external beam radiotherapy. 1 (TIFF 902 kb)

345_2018_2310_MOESM2_ESM.tiff

Supplementary Figure 2. Cumulative incidence plots depicting other cause mortality rates in 1,866 cT3N0-1 prostate cancer after other cause mortality propensity score matching stratified according to treatment received: radical prostatectomy vs. external beam radiotherapy. 2 (TIFF 902 kb)

Supplementary material 3 (DOCX 12 kb)

Supplementary material 4 (DOCX 15 kb)

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Bandini, M., Marchioni, M., Preisser, F. et al. Survival after radical prostatectomy or radiotherapy for locally advanced (cT3) prostate cancer. World J Urol 36, 1399–1407 (2018). https://doi.org/10.1007/s00345-018-2310-y

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  • DOI: https://doi.org/10.1007/s00345-018-2310-y

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