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Eur Urol. 2017 Jul;72(1):125-134. doi: 10.1016/j.eururo.2016.07.023. Epub 2016 Aug 5.

Association of Radical Local Treatment with Mortality in Men with Very High-risk Prostate Cancer: A Semiecologic, Nationwide, Population-based Study.

Author information

1
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University Hospital, Umeå, Sweden. Electronic address: par.stattin@umu.se.
2
Regional Cancer Centre Uppsala Örebro, Uppsala University Hospital, Uppsala, Sweden.
3
Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
4
Regional Cancer Centre Uppsala Örebro, Uppsala University Hospital, Uppsala, Sweden; King's College London, School of Medicine, Division of Cancer Studies, Cancer Epidemiology Group, London, UK.
5
Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University Hospital, Umeå, Sweden; Department of Urology, Ryhov Hospital, Jönköping, Sweden.
6
Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
7
Department of Radiation Sciences, Umeå University, Umeå, Sweden.
8
Department of Translational Medicine, Division of Urological Cancer, Lund University, Lund, Sweden; CamPARI Clinic, Department of Urology, Cambridge University Hospitals, Cambridge, UK.

Abstract

BACKGROUND:

Current guidelines recommend androgen deprivation therapy only for men with very high-risk prostate cancer (PCa), but there is little evidence to support this stance.

OBJECTIVE:

To investigate the association between radical local treatment and mortality in men with very high-risk PCa.

DESIGN, SETTING, AND PARTICIPANTS:

Semiecologic study of men aged <80 yr within the Prostate Cancer data Base Sweden, diagnosed in 1998-2012 with very high-risk PCa (local clinical stage T4 and/or prostate-specific antigen [PSA] level 50-200ng/ml, any N, and M0). Men with locally advanced PCa (local clinical stage T3 and PSA level <50ng/ml, any N, and M0) were used as positive controls.

INTERVENTION:

Proportion of men who received prostatectomy or full-dose radiotherapy in 640 experimental units defined by county, diagnostic period, and age at diagnosis.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:

PCa and all-cause mortality rate ratios (MRRs).

RESULTS AND LIMITATIONS:

Both PCa and all-cause mortality were half as high in units in the highest tertile of exposure to radical local treatment compared with units in the lowest tertile (PCa MRR: 0.51; 95% confidence interval [CI], 0.28-0.95; and all-cause MRR: 0.56; 95% CI, 0.33-0.92). The results observed for locally advanced PCa for highest versus lowest tertile of exposure were in agreement with results from randomized trials (PCa MRR: 0.75; 95% CI, 0.60-0.94; and all-cause MRR: 0.85; 95% CI, 0.72-1.00). Although the semiecologic design minimized selection bias on an individual level, the effect of high therapeutic activity could not be separated from that of high diagnostic activity.

CONCLUSIONS:

The substantially lower mortality in units with the highest exposure to radical local treatment suggests that radical treatment decreases mortality even in men with very high-risk PCa for whom such treatment has been considered ineffective.

PATIENT SUMMARY:

Men with very high-risk prostate cancer diagnosed and treated in units with the highest exposure to surgery or radiotherapy had a substantially lower mortality.

KEYWORDS:

Nationwide; PCBaSe; Population-based; Prostate cancer; Radical; Semiecologic; Treatment; Very high-risk

PMID:
27481175
DOI:
10.1016/j.eururo.2016.07.023
[Indexed for MEDLINE]
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