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Can Urol Assoc J. 2009 Feb;3(1):13-21.

Survival after radical prostatectomy and radiotherapy for prostate cancer: a population-based study.

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Cancer Prognostics and Health Outcomes Unit, University of Montréal Health Centre (CHUM), Montréal, Que., and the.



Based on the natural history of localized prostate cancer, the life expectancy (LE) of men treated with either radical prostatectomy (RP) or definitive external-beam radiotherapy (EBRT) should exceed 10 years. To test this hypothesis, we examined overall survival rates after RP or EBRT in a contemporary population-based cohort.


Within a population-based cohort we assessed crude survival in 17 570 men diagnosed with prostate cancer who were either treated with RP (n = 9678) or definitive EBRT (n = 7892) between 1989 and 2000. Age and Charlson Comorbidity Index (CCI) score at treatment represented covariates. In order to control for prostate cancer-related mortality, we repeated analyses for 9131 men who did not receive any secondary treatment for prostate cancer.


In the entire cohort, the actuarial 10-year survival probability after RP was 75.3%, versus 36.7% after EBRT (p < 0.001). In those who did not receive any secondary treatment, the actuarial 10-year survival probability after RP was 81.1%, versus 30.4% after EBRT (p < 0.001). In multivariate Cox regression models, EBRT was associated with a 2.8-fold (p < 0.001) and 3.9-fold (p < 0.001) higher risk of mortality in the entire cohort and in the cohort without secondary treatment, respectively. Increased CCI score and increased age were also associated with a higher risk of mortality (p < 0.001).


Some men treated with EBRT and, to a lesser extent, those treated with RP may have insufficient LE to warrant therapy with curative intent. More stringent selection criteria are necessary to avoid overtreatment.

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