Prostate Cancer Death After Radiotherapy or Radical Prostatectomy: A Nationwide Population-based Observational Study

David Robinson; Hans Garmo; Ingela Franck Lissbrant; Anders Widmark; Andreas Pettersson; Adalsteinn Gunnlaugsson; Jan Adolfsson; Ola Bratt; Per Nilsson; Pär Stattin

doi:10.1016/j.eururo.2017.11.039

Prostate Cancer Death After Radiotherapy or Radical Prostatectomy: A Nationwide Population-based Observational Study

David Robinson, Hans Garmo, Ingela Franck Lissbrant, Anders Widmark, Andreas Pettersson, Adalsteinn Gunnlaugsson, Jan Adolfsson, Ola Bratt, Per Nilsson, Pär Stattin

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Abstract

Background
There are no conclusive results from randomized trials on radiotherapy (RT) versus radical prostatectomy (RP) for prostate cancer. Numerous observational studies have suggested that RP is associated with a lower risk of prostate cancer death, but whether results have been biased due to limited adjustments for confounding factors is unknown.

Objective
To compare the risk of prostate cancer death after RT versus RP.

Design, setting, and participants
Nationwide population-based observational study of men in the Prostate Cancer data Base Sweden 3.0 who had undergone RT or RP between 1998 and 2012.

Outcome measurements and statistical analysis
Prostate cancer deaths were compared. Hazard ratios (HRs) were calculated in Cox regression models, including clinical T stage, M stage, Gleason grade group, serum levels of prostate-specific antigen, proportion of biopsy cores with cancer, mode of detection, comorbidity, age, educational level, and civil status. Period analysis with left truncation was performed.

Results and limitations
Primary treatment was RT or RP for 41 503 men. Treatment effect was associated with disease severity. In univariate analysis of RT versus RP, risk of prostate cancer death was higher after RT—low- and intermediate-risk cancer, HR 1.82 (95% confidence interval [CI]: 1.53–2.16), and high-risk cancer, HR 1.57 (95% CI: 1.33–1.85). After full adjustment in period analysis, this difference between the treatments was attenuated—low- and intermediate-risk cancer, HR 1.24 (95% CI: 0.97–1.58), and high-risk cancer, HR 1.03 (95% CI: 0.81–1.31). Confounding remained due to nonrandom allocation to treatment.

Conclusions
In comparison with previous studies, the difference in prostate cancer mortality after RT and RP was much smaller.

Patient summary
The difference in prostate cancer mortality after contemporary radiotherapy and radical prostatectomy was small in contrast to previous studies, indicating that potential side effects should be more emphasized when selecting treatment.

Original language	English
Journal	European Urology
Early online date	15 Dec 2017
DOIs	https://doi.org/10.1016/j.eururo.2017.11.039
Publication status	E-pub ahead of print - 15 Dec 2017

Keywords

Prostate cancer
Radiotherapy
Radical prostatectomy

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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@article{490b56bcd5c444779f8fb331487c3494,

title = "Prostate Cancer Death After Radiotherapy or Radical Prostatectomy: A Nationwide Population-based Observational Study",

abstract = "BackgroundThere are no conclusive results from randomized trials on radiotherapy (RT) versus radical prostatectomy (RP) for prostate cancer. Numerous observational studies have suggested that RP is associated with a lower risk of prostate cancer death, but whether results have been biased due to limited adjustments for confounding factors is unknown.ObjectiveTo compare the risk of prostate cancer death after RT versus RP.Design, setting, and participantsNationwide population-based observational study of men in the Prostate Cancer data Base Sweden 3.0 who had undergone RT or RP between 1998 and 2012.Outcome measurements and statistical analysisProstate cancer deaths were compared. Hazard ratios (HRs) were calculated in Cox regression models, including clinical T stage, M stage, Gleason grade group, serum levels of prostate-specific antigen, proportion of biopsy cores with cancer, mode of detection, comorbidity, age, educational level, and civil status. Period analysis with left truncation was performed.Results and limitationsPrimary treatment was RT or RP for 41 503 men. Treatment effect was associated with disease severity. In univariate analysis of RT versus RP, risk of prostate cancer death was higher after RT—low- and intermediate-risk cancer, HR 1.82 (95% confidence interval [CI]: 1.53–2.16), and high-risk cancer, HR 1.57 (95% CI: 1.33–1.85). After full adjustment in period analysis, this difference between the treatments was attenuated—low- and intermediate-risk cancer, HR 1.24 (95% CI: 0.97–1.58), and high-risk cancer, HR 1.03 (95% CI: 0.81–1.31). Confounding remained due to nonrandom allocation to treatment.ConclusionsIn comparison with previous studies, the difference in prostate cancer mortality after RT and RP was much smaller.Patient summaryThe difference in prostate cancer mortality after contemporary radiotherapy and radical prostatectomy was small in contrast to previous studies, indicating that potential side effects should be more emphasized when selecting treatment.",

keywords = "Prostate cancer, Radiotherapy, Radical prostatectomy",

author = "David Robinson and Hans Garmo and Lissbrant, {Ingela Franck} and Anders Widmark and Andreas Pettersson and Adalsteinn Gunnlaugsson and Jan Adolfsson and Ola Bratt and Per Nilsson and P{\"a}r Stattin",

year = "2017",

month = dec,

day = "15",

doi = "10.1016/j.eururo.2017.11.039",

language = "English",

journal = "European Urology",

issn = "0302-2838",

publisher = "Elsevier",

}

TY - JOUR

T1 - Prostate Cancer Death After Radiotherapy or Radical Prostatectomy

T2 - A Nationwide Population-based Observational Study

AU - Robinson, David

AU - Garmo, Hans

AU - Lissbrant, Ingela Franck

AU - Widmark, Anders

AU - Pettersson, Andreas

AU - Gunnlaugsson, Adalsteinn

AU - Adolfsson, Jan

AU - Bratt, Ola

AU - Nilsson, Per

AU - Stattin, Pär

PY - 2017/12/15

Y1 - 2017/12/15

N2 - BackgroundThere are no conclusive results from randomized trials on radiotherapy (RT) versus radical prostatectomy (RP) for prostate cancer. Numerous observational studies have suggested that RP is associated with a lower risk of prostate cancer death, but whether results have been biased due to limited adjustments for confounding factors is unknown.ObjectiveTo compare the risk of prostate cancer death after RT versus RP.Design, setting, and participantsNationwide population-based observational study of men in the Prostate Cancer data Base Sweden 3.0 who had undergone RT or RP between 1998 and 2012.Outcome measurements and statistical analysisProstate cancer deaths were compared. Hazard ratios (HRs) were calculated in Cox regression models, including clinical T stage, M stage, Gleason grade group, serum levels of prostate-specific antigen, proportion of biopsy cores with cancer, mode of detection, comorbidity, age, educational level, and civil status. Period analysis with left truncation was performed.Results and limitationsPrimary treatment was RT or RP for 41 503 men. Treatment effect was associated with disease severity. In univariate analysis of RT versus RP, risk of prostate cancer death was higher after RT—low- and intermediate-risk cancer, HR 1.82 (95% confidence interval [CI]: 1.53–2.16), and high-risk cancer, HR 1.57 (95% CI: 1.33–1.85). After full adjustment in period analysis, this difference between the treatments was attenuated—low- and intermediate-risk cancer, HR 1.24 (95% CI: 0.97–1.58), and high-risk cancer, HR 1.03 (95% CI: 0.81–1.31). Confounding remained due to nonrandom allocation to treatment.ConclusionsIn comparison with previous studies, the difference in prostate cancer mortality after RT and RP was much smaller.Patient summaryThe difference in prostate cancer mortality after contemporary radiotherapy and radical prostatectomy was small in contrast to previous studies, indicating that potential side effects should be more emphasized when selecting treatment.

AB - BackgroundThere are no conclusive results from randomized trials on radiotherapy (RT) versus radical prostatectomy (RP) for prostate cancer. Numerous observational studies have suggested that RP is associated with a lower risk of prostate cancer death, but whether results have been biased due to limited adjustments for confounding factors is unknown.ObjectiveTo compare the risk of prostate cancer death after RT versus RP.Design, setting, and participantsNationwide population-based observational study of men in the Prostate Cancer data Base Sweden 3.0 who had undergone RT or RP between 1998 and 2012.Outcome measurements and statistical analysisProstate cancer deaths were compared. Hazard ratios (HRs) were calculated in Cox regression models, including clinical T stage, M stage, Gleason grade group, serum levels of prostate-specific antigen, proportion of biopsy cores with cancer, mode of detection, comorbidity, age, educational level, and civil status. Period analysis with left truncation was performed.Results and limitationsPrimary treatment was RT or RP for 41 503 men. Treatment effect was associated with disease severity. In univariate analysis of RT versus RP, risk of prostate cancer death was higher after RT—low- and intermediate-risk cancer, HR 1.82 (95% confidence interval [CI]: 1.53–2.16), and high-risk cancer, HR 1.57 (95% CI: 1.33–1.85). After full adjustment in period analysis, this difference between the treatments was attenuated—low- and intermediate-risk cancer, HR 1.24 (95% CI: 0.97–1.58), and high-risk cancer, HR 1.03 (95% CI: 0.81–1.31). Confounding remained due to nonrandom allocation to treatment.ConclusionsIn comparison with previous studies, the difference in prostate cancer mortality after RT and RP was much smaller.Patient summaryThe difference in prostate cancer mortality after contemporary radiotherapy and radical prostatectomy was small in contrast to previous studies, indicating that potential side effects should be more emphasized when selecting treatment.

KW - Prostate cancer

KW - Radiotherapy

KW - Radical prostatectomy

U2 - 10.1016/j.eururo.2017.11.039

DO - 10.1016/j.eururo.2017.11.039

M3 - Article

SN - 0302-2838

JO - European Urology

JF - European Urology

ER -

Prostate Cancer Death After Radiotherapy or Radical Prostatectomy: A Nationwide Population-based Observational Study

Abstract

Keywords

UN SDGs

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