The optimal therapy for management of prostate cancer is still debatable. Through the use of a large population-based retrospective cohort study of prostate cancer patients, we investigated the association of overall survival (OS) and disease specific survival (DSS) with standard treatment modalities including: brachytherapy (BT), external beam radiation therapy (EBRT), radical prostatectomy (RP), hormonal therapy (HT), and watchful waiting/active surveillance (WW/AS).
Materials/Methods
Using the Ohio Cancer-Aging Linked Database developed by linking records from the Ohio Cancer Incidence Surveillance System with Medicare and Death Certificate files, we identified a cohort of N = 11,453 men 65 years and older with incident prostate cancer diagnosed between 1999 and 2001. We analyzed the 7-year OS and DSS among the 5 different clinically accepted procedures including curative therapies such as BT, EBRT, and RP, versus HT alone used for conservative management of disease progression or by WW/AS observation. The patient attributes that were accounted for included: age, race, comorbidities, cancer stage, Gleason score, and treatment method.
Results
OS and DSS rates were 65.8% and 89.7% for the whole cohort at 7-year, respectively. DSS rates were 93.0% and 30.1% for the patients with localized disease versus patients who presented with distant adenocarcinoma of the prostate, respectively. For the localized-disease cohort, the DSS rates were 97.8%, 97.0%, 92.8%, 91.6%, and 89.1% at 7-year, for RP, BT, EBRT, WW/AS, or HT treatment groups; respectively. After controlling for age, race, comorbidities, stage, and Gleason score, the hazard of prostate cancer specific death was similar in patients receiving EBRT compared to RP; and marginally better for men receiving BT than RP (Hazard ratio = 0.7, 0.47–1.03). Additionally, a 1.6–2.1 folds higher hazard ratio was identified among those who did not undergo a curative interventions such as RP, BT, or EBRT within 6 months following initial diagnosis of localized disease.
Conclusions
Large population-based studies on survival may provide useful and important insights for use by physicians and patients in determining appropriate disease management. After controlling for patient age, race, comorbidities, cancer stage and Gleason score, we show in this study that patients in the treatment groups for curative therapy (BT, RP or EBRT) demonstrate improved DSS compared to those without curative therapy initiated within 6 months of presenting with localized disease. These data indicate that additional study is warranted, to improve clinical determinates in the selection of appropriate management of prostate cancer, and to improve predictive modeling for which patient subsets may benefit most from definitive therapy, versus conservative management and/or observation.
1Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH
2Department of Urology, University Hospital of Cleveland, Cleveland, OH
3Department of Radiation Oncology, Aultman Hospital, Canton, OH
4Department of Medicine, Case Western Reserve University, Cleveland, OH
5Department of Radiation Oncology, Case Western Reserve University, Cleveland, OH
Author Disclosure: E.H. Zhou, None; R.J. Ellis, None; F. Xu, None; E. Cherullo, None; S. Gupta, None; A. Storfer-Isser, None; W. Chen, None; V. Collussi, None; D.A. Kaminsky, None; S.M. Koroukian, National Cancer Institute (K07 CA096705), B. Research Grant.
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