A Competing Risk Analysis of Cancer-Specific Mortality of Initial Treatment with Radical Prostatectomy versus Radiation Therapy in Clinically Localized High-Risk Prostate Cancer

Joo Yong Lee, Kang Su Cho, Jong Kyou Kwon, Seong Uk Jeh, Ho Won Kang, Richilda Red Diaz, Won Sik Ham, Woong Sub Koom, Ki Chang Keum, Youngdeuk Choi

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background: There is no consensus on the optimal treatment for localized high-risk prostate cancer (PC), and much debate exists regarding the ideal treatment approach. For these reasons, we evaluated the competing risks of PC-specific mortality after initial therapy with radical prostatectomy (RP) versus radiotherapy (RT) in men with clinically localized high-risk PC.

Methods: We reviewed patients treated with RP and RT combined with androgen-deprivation therapy between 1990 and 2009. High-risk PC is defined as clinical stage ≥T3a, serum prostate-specific antigen (PSA) >20 ng/mL, or a biopsy Gleason sum of 8–10 according to National Comprehensive Cancer Network guidelines. Competing risk analysis was conducted to assess the association of RP (n = 251) or RT (n = 125) with cancer-specific mortality (CSM). Thereafter, secondary analysis with propensity score matching was conducted to further elucidate patient characteristics, with optimal matching of 0.25 times the standard deviation of propensity scores.

Results: With an overall median follow-up of 76 months, 35 (9.3 %) men with high-risk PC died due to PC (23 in the RT group and 12 in the RP group). The 5-year estimates of cancer-specific survival rate for men treated with RP and RT were 96.5 % (95 % confidence interval [CI] 94.2–98.9) and 88.3 % (95 % CI 82.8–94.3), respectively. Cumulative incidence estimates for CSM were statistically increased amongst men treated with RT (p = 0.002). Propensity score matching extracted 168 men with high-risk PC from the total patient cohort. Cumulative incidence estimates for CSM were statistically different amongst men treated with RT (p < 0.001).

Conclusions: Initial treatment with RP versus RT was associated with a decreased risk of CSM in men with clinically localized high-risk PC.

Original languageEnglish
Pages (from-to)4026-4033
Number of pages8
JournalAnnals of Surgical Oncology
Volume21
Issue number12
DOIs
Publication statusPublished - 2014 Oct 8

Fingerprint

Prostatectomy
Prostatic Neoplasms
Radiotherapy
Mortality
Neoplasms
Propensity Score
Therapeutics
Confidence Intervals
Incidence
Prostate-Specific Antigen
Androgens
Survival Rate
Guidelines
Biopsy
Serum

All Science Journal Classification (ASJC) codes

  • Surgery
  • Oncology

Cite this

Lee, Joo Yong ; Cho, Kang Su ; Kwon, Jong Kyou ; Jeh, Seong Uk ; Kang, Ho Won ; Diaz, Richilda Red ; Ham, Won Sik ; Koom, Woong Sub ; Keum, Ki Chang ; Choi, Youngdeuk. / A Competing Risk Analysis of Cancer-Specific Mortality of Initial Treatment with Radical Prostatectomy versus Radiation Therapy in Clinically Localized High-Risk Prostate Cancer. In: Annals of Surgical Oncology. 2014 ; Vol. 21, No. 12. pp. 4026-4033.
@article{35bb3ed7ca97425da5ac6a6f101fa53c,
title = "A Competing Risk Analysis of Cancer-Specific Mortality of Initial Treatment with Radical Prostatectomy versus Radiation Therapy in Clinically Localized High-Risk Prostate Cancer",
abstract = "Background: There is no consensus on the optimal treatment for localized high-risk prostate cancer (PC), and much debate exists regarding the ideal treatment approach. For these reasons, we evaluated the competing risks of PC-specific mortality after initial therapy with radical prostatectomy (RP) versus radiotherapy (RT) in men with clinically localized high-risk PC.Methods: We reviewed patients treated with RP and RT combined with androgen-deprivation therapy between 1990 and 2009. High-risk PC is defined as clinical stage ≥T3a, serum prostate-specific antigen (PSA) >20 ng/mL, or a biopsy Gleason sum of 8–10 according to National Comprehensive Cancer Network guidelines. Competing risk analysis was conducted to assess the association of RP (n = 251) or RT (n = 125) with cancer-specific mortality (CSM). Thereafter, secondary analysis with propensity score matching was conducted to further elucidate patient characteristics, with optimal matching of 0.25 times the standard deviation of propensity scores.Results: With an overall median follow-up of 76 months, 35 (9.3 {\%}) men with high-risk PC died due to PC (23 in the RT group and 12 in the RP group). The 5-year estimates of cancer-specific survival rate for men treated with RP and RT were 96.5 {\%} (95 {\%} confidence interval [CI] 94.2–98.9) and 88.3 {\%} (95 {\%} CI 82.8–94.3), respectively. Cumulative incidence estimates for CSM were statistically increased amongst men treated with RT (p = 0.002). Propensity score matching extracted 168 men with high-risk PC from the total patient cohort. Cumulative incidence estimates for CSM were statistically different amongst men treated with RT (p < 0.001).Conclusions: Initial treatment with RP versus RT was associated with a decreased risk of CSM in men with clinically localized high-risk PC.",
author = "Lee, {Joo Yong} and Cho, {Kang Su} and Kwon, {Jong Kyou} and Jeh, {Seong Uk} and Kang, {Ho Won} and Diaz, {Richilda Red} and Ham, {Won Sik} and Koom, {Woong Sub} and Keum, {Ki Chang} and Youngdeuk Choi",
year = "2014",
month = "10",
day = "8",
doi = "10.1245/s10434-014-3780-9",
language = "English",
volume = "21",
pages = "4026--4033",
journal = "Annals of Surgical Oncology",
issn = "1068-9265",
publisher = "Springer New York",
number = "12",

}

A Competing Risk Analysis of Cancer-Specific Mortality of Initial Treatment with Radical Prostatectomy versus Radiation Therapy in Clinically Localized High-Risk Prostate Cancer. / Lee, Joo Yong; Cho, Kang Su; Kwon, Jong Kyou; Jeh, Seong Uk; Kang, Ho Won; Diaz, Richilda Red; Ham, Won Sik; Koom, Woong Sub; Keum, Ki Chang; Choi, Youngdeuk.

In: Annals of Surgical Oncology, Vol. 21, No. 12, 08.10.2014, p. 4026-4033.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A Competing Risk Analysis of Cancer-Specific Mortality of Initial Treatment with Radical Prostatectomy versus Radiation Therapy in Clinically Localized High-Risk Prostate Cancer

AU - Lee, Joo Yong

AU - Cho, Kang Su

AU - Kwon, Jong Kyou

AU - Jeh, Seong Uk

AU - Kang, Ho Won

AU - Diaz, Richilda Red

AU - Ham, Won Sik

AU - Koom, Woong Sub

AU - Keum, Ki Chang

AU - Choi, Youngdeuk

PY - 2014/10/8

Y1 - 2014/10/8

N2 - Background: There is no consensus on the optimal treatment for localized high-risk prostate cancer (PC), and much debate exists regarding the ideal treatment approach. For these reasons, we evaluated the competing risks of PC-specific mortality after initial therapy with radical prostatectomy (RP) versus radiotherapy (RT) in men with clinically localized high-risk PC.Methods: We reviewed patients treated with RP and RT combined with androgen-deprivation therapy between 1990 and 2009. High-risk PC is defined as clinical stage ≥T3a, serum prostate-specific antigen (PSA) >20 ng/mL, or a biopsy Gleason sum of 8–10 according to National Comprehensive Cancer Network guidelines. Competing risk analysis was conducted to assess the association of RP (n = 251) or RT (n = 125) with cancer-specific mortality (CSM). Thereafter, secondary analysis with propensity score matching was conducted to further elucidate patient characteristics, with optimal matching of 0.25 times the standard deviation of propensity scores.Results: With an overall median follow-up of 76 months, 35 (9.3 %) men with high-risk PC died due to PC (23 in the RT group and 12 in the RP group). The 5-year estimates of cancer-specific survival rate for men treated with RP and RT were 96.5 % (95 % confidence interval [CI] 94.2–98.9) and 88.3 % (95 % CI 82.8–94.3), respectively. Cumulative incidence estimates for CSM were statistically increased amongst men treated with RT (p = 0.002). Propensity score matching extracted 168 men with high-risk PC from the total patient cohort. Cumulative incidence estimates for CSM were statistically different amongst men treated with RT (p < 0.001).Conclusions: Initial treatment with RP versus RT was associated with a decreased risk of CSM in men with clinically localized high-risk PC.

AB - Background: There is no consensus on the optimal treatment for localized high-risk prostate cancer (PC), and much debate exists regarding the ideal treatment approach. For these reasons, we evaluated the competing risks of PC-specific mortality after initial therapy with radical prostatectomy (RP) versus radiotherapy (RT) in men with clinically localized high-risk PC.Methods: We reviewed patients treated with RP and RT combined with androgen-deprivation therapy between 1990 and 2009. High-risk PC is defined as clinical stage ≥T3a, serum prostate-specific antigen (PSA) >20 ng/mL, or a biopsy Gleason sum of 8–10 according to National Comprehensive Cancer Network guidelines. Competing risk analysis was conducted to assess the association of RP (n = 251) or RT (n = 125) with cancer-specific mortality (CSM). Thereafter, secondary analysis with propensity score matching was conducted to further elucidate patient characteristics, with optimal matching of 0.25 times the standard deviation of propensity scores.Results: With an overall median follow-up of 76 months, 35 (9.3 %) men with high-risk PC died due to PC (23 in the RT group and 12 in the RP group). The 5-year estimates of cancer-specific survival rate for men treated with RP and RT were 96.5 % (95 % confidence interval [CI] 94.2–98.9) and 88.3 % (95 % CI 82.8–94.3), respectively. Cumulative incidence estimates for CSM were statistically increased amongst men treated with RT (p = 0.002). Propensity score matching extracted 168 men with high-risk PC from the total patient cohort. Cumulative incidence estimates for CSM were statistically different amongst men treated with RT (p < 0.001).Conclusions: Initial treatment with RP versus RT was associated with a decreased risk of CSM in men with clinically localized high-risk PC.

UR - http://www.scopus.com/inward/record.url?scp=84918801838&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84918801838&partnerID=8YFLogxK

U2 - 10.1245/s10434-014-3780-9

DO - 10.1245/s10434-014-3780-9

M3 - Article

C2 - 24841351

AN - SCOPUS:84918801838

VL - 21

SP - 4026

EP - 4033

JO - Annals of Surgical Oncology

JF - Annals of Surgical Oncology

SN - 1068-9265

IS - 12

ER -