Presentation Authors: Annika Herlemann*, Janet E. Cowan, Samuel L. Washington III, Jeanette M. Broering, Peter R. Carroll, Matthew R. Cooperberg, San Francisco, CA
Introduction: We provide updated comparative effectiveness based on long-term, 18-year prostate cancer-specific mortality (PCSM) among men who underwent radical prostatectomy (RP), men who received brachytherapy (BT), external-beam radiation therapy (EBRT), primary androgen deprivation therapy (PADT) or monitoring (AS/WW) for localized prostate cancer.
Methods: Within the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry, we analyzed 9,774 men with localized prostate cancer. Prostate cancer risk was assessed using the Kattan preoperative nomogram and the Cancer of the Prostate Risk Assessment (CAPRA) score. A multivariable analysis was performed to compare PCSM by primary treatment adjusting for age and case-mix.
Results: 5,235 (54%) underwent RP, 1,138 (12%) BT, 1,307 (13%) EBRT, 1,262 (13%) PADT, and 832 (9%) AS/WW. During the 18-year follow-up period, 319 men (3%) died from prostate cancer. Median months to PCSM within 18 years were 70 (IQR 42-108). Adjusting for clinical CAPRA score the hazard ratios for PCSM relative to RP for BT, EBRT, PADT and AS/WW were 1.58 (95% CI, 1.04-2.40, p=0.03), 2.08 (95% CI, 1.54-2.82, p < 0.01), 3.01 (95% CI, 2.22-4.10, p < 0.01), and 2.07 (95% CI, 1.33-3.21, p < 0.01), respectively. Two additional analyses using 100-Kattan score and a de novo model demonstrated similar results. In low-risk patients, no treatment modality showed a significant prostate-cancer specific survival benefit.
Conclusions: In a large, prospective, multi-center cohort of men with PCa, after rigorous case-mix adjustment, risk of PCa mortality was lowest with RP. Mortality was substantially higher with EBRT and AS/WW, and highest with PADT. The greatest difference was observed for high-risk patients. Therefore, we advise an increased role for RP in high-risk disease, and for AS/WW in low-risk disease.
Source of Funding: This work was supported by the U.S. Department of Defense Prostate Cancer Research Program W81XWH-13-2-0074.