Radiotherapy and Survival in Prostate Cancer Patients: A Population-Based Study
Received 19 December 2007; received in revised form 6 March 2008; accepted 25 April 2008. published online 05 June 2008.
Purpose
To investigate the association of overall and disease-specific survival with the five standard treatment modalities for prostate cancer (CaP): radical prostatectomy (RP), brachytherapy (BT), external beam radiotherapy, androgen deprivation therapy, and no treatment (NT) within 6 months after CaP diagnosis.
Methods and Materials
The study population included 10,179 men aged 65 years and older with incident CaP diagnosed between 1999 and 2001. Using the linked Ohio Cancer Incidence Surveillance System, Medicare, and death certificate files, overall and disease-specific survival through 2005 among the five clinically accepted therapies were analyzed.
Results
Disease-specific survival rates were 92.3% and 23.9% for patients with localized vs. distant disease at 7 years, respectively. Controlling for age, race, comorbidities, stage, and Gleason score, results from the Cox multiple regression models indicated that the risk of CaP-specific death was significantly reduced in patients receiving RP or BT, compared with NT. For localized disease, compared with NT, in the monotherapy cohort, RP and BT were associated with reduced hazard ratios (HR) of 0.25 and 0.45 (95% confidence intervals 0.13–0.48 and 0.23–0.87, respectively), whereas in the combination therapy cohort, HR were 0.40 (0.17–0.94) and 0.46 (0.27–0.80), respectively.
Conclusions
The present population-based study indicates that RP and BT are associated with improved survival outcomes. Further studies are warranted to improve clinical determinates in the selection of appropriate management of CaP and to improve predictive modeling for which patient subsets may benefit most from definitive therapy vs. conservative management and/or observation.
#Case Comprehensive Cancer Center, Cancer-Aging Program, Cleveland, OH
‡Department of Radiology, Northeastern Ohio Universities College of Medicine, Rootstown, OH
Reprint requests to: Esther Hang Zhou, M.D., Department of Urology, Case School of Medicine, 11100 Euclid Ave., Lakeside Room 4560, Cleveland, OH 44106-5046. Tel: (216) 844-5662; Fax: (216) 844-1900
Supported by a Career Development Grant from the National Cancer Institute (K07 CA096705 to S.M.K.), and a National Institutes of Health Cancer-Aging Research Development Grant (P20 CA103736 to Dr. Nathan Berger, Case School of Medicine; S.M.K., pilot project investigator).
Disclaimer: Cancer incidence data were obtained from the Ohio Cancer Incidence Surveillance System (OCISS), Ohio Department of Health. Use of these data does not imply that the Ohio Department of Health either agrees or disagrees with any presentation, analyses, interpretations, or conclusions. Information about the OCISS may be obtained at www.odh.ohio.gov/odhprograms/svio/ci_surv/ci_surv1.aspx.
This article is dedicated to Dr. Martin I. Resnick, in memory of a beloved mentor and a devoted supporter of our research.
ABSTRACT