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1103 SURVIVAL ANALYSIS AFTER PROSTATE CANCER TREATMENT AMONG HEALTHY MEN: MULTI-INSTITUTIONAL STUDY OF 6692 PATIENTS

2011; Lippincott Williams & Wilkins; Volume: 185; Issue: 4S Linguagem: Inglês

10.1016/j.juro.2011.02.2619

1527-3792

Kenneth G. Nepple, Andrew J. Stephenson, Dorina Kallogjeri, Jeff M. Michalski, Robert L. Grubb, Seth A. Strope, Jennifer Haslag-Minoff, Jay F. Piccirillo, Jay P. Ciezki, Eric A. Klein, Chandana Reddy, Changhong Yu, Michael W. Kattan, Adam S. Kibel,

Health Systems, Economic Evaluations, Quality of Life

You have accessJournal of UrologyProstate Cancer: Localized1 Apr 20111103 SURVIVAL ANALYSIS AFTER PROSTATE CANCER TREATMENT AMONG HEALTHY MEN: MULTI-INSTITUTIONAL STUDY OF 6692 PATIENTS Kenneth Nepple, Andrew Stephenson, Dorina Kallogjeri, Jeff Michalski, Robert Grubb, Seth Strope, Jennifer Haslag-Minoff, Jay Piccirillo, Jay Ciezki, Eric Klein, Chandana Reddy, Changhong Yu, Michael Kattan, and Adam Kibel Kenneth NeppleKenneth Nepple St. Louis, MO More articles by this author , Andrew StephensonAndrew Stephenson Cleveland, OH More articles by this author , Dorina KallogjeriDorina Kallogjeri St. Louis, MO More articles by this author , Jeff MichalskiJeff Michalski St. Louis, MO More articles by this author , Robert GrubbRobert Grubb St. Louis, MO More articles by this author , Seth StropeSeth Strope St. Louis, MO More articles by this author , Jennifer Haslag-MinoffJennifer Haslag-Minoff St. Louis, MO More articles by this author , Jay PiccirilloJay Piccirillo St. Louis, MO More articles by this author , Jay CiezkiJay Ciezki Cleveland, OH More articles by this author , Eric KleinEric Klein Cleveland, OH More articles by this author , Chandana ReddyChandana Reddy Cleveland, OH More articles by this author , Changhong YuChanghong Yu Cleveland, OH More articles by this author , Michael KattanMichael Kattan Cleveland, OH More articles by this author , and Adam KibelAdam Kibel St. Louis, MO More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2619AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The risks of competing causes of mortality associated with age and medical comorbidity are of paramount importance in prostate cancer treatment decision-making. A clear bias exists among cancer specialists for radiation therapy in patients of advanced age and/or significant comorbid illness. In the absence of randomization, this imbalance of confounders makes valid comparisons among treatments difficult. To minimize this problem, we compared survival between treatments for men with no medical comorbidity and stratified by age. METHODS We reviewed 10361 men with prostate cancer treated at two centers from 1995 to 2007. Pretreatment medical comorbidity was measured by validated comorbidity indices. 6692 men with no recorded medical comorbidities underwent radical prostatectomy (RP), external-beam radiotherapy (EBR), or brachytherapy (BT). Patients were stratified by age <65 or ≥65 years. Analyses with Cox proportional hazards identified variables associated with survival (PCM=prostate cancer mortality, OM=overall mortality) which were incorporated into a multivariate Cox model with RP as the reference group with hazard ratio (HR) of 1.0. RESULTS Treatment utilization differed in men under age 65 (RP: 3361, EBR: 393, BT: 398) compared to age 65 and over (RP: 1098, EBR: 868, BT: 574). Over a median follow-up of 66.4 months, 538 of 6692 men died including 101 of PCM. In multivariable analysis, no significant differences were observed in PCM between treatments for men younger (EBR HR 1.33, p=0.45; BT HR 1.88, p=0.31) or older than 65 years (EBR HR 1.50, p=0.21; BT HR 0.95, p=0.93). In patients under age 65, EBR was associated with increased OM (HR 1.51, 95% CI: 1.02–2.21, p=0.04) compared to RP while BT and RP were equivalent. (HR 1.29, CI: 0.71–2.36, p=0.40). In patients age 65 and over, both EBR and BT were associated with an increased overall mortality compared to radical prostatectomy (EBR HR 1.49, 95% CI: 1.14–1.94, p<0.01; BTX HR 1.66, 95% CI: 1.18–2.32, p<0.01, respectively). CONCLUSIONS Among healthy men without recorded comorbidities, PCM was equivalent among treatments. Compared to RP, increased OM was observed after EBR and in older men after BT. Differences may be due to uncontrolled confounding variables, treatment toxicity, or difficult ascertaining cause of death from death certificates. Important limitations include few prostate cancer deaths at a median follow up of ∼5 years and lack of randomization. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e443-e444 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kenneth Nepple St. Louis, MO More articles by this author Andrew Stephenson Cleveland, OH More articles by this author Dorina Kallogjeri St. Louis, MO More articles by this author Jeff Michalski St. Louis, MO More articles by this author Robert Grubb St. Louis, MO More articles by this author Seth Strope St. Louis, MO More articles by this author Jennifer Haslag-Minoff St. Louis, MO More articles by this author Jay Piccirillo St. Louis, MO More articles by this author Jay Ciezki Cleveland, OH More articles by this author Eric Klein Cleveland, OH More articles by this author Chandana Reddy Cleveland, OH More articles by this author Changhong Yu Cleveland, OH More articles by this author Michael Kattan Cleveland, OH More articles by this author Adam Kibel St. Louis, MO More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...