Association of Radical Local Treatment with Mortality in Men with Very High-risk Prostate Cancer : A Semiecologic, Nationwide, Population-based Study
(2017) In European Urology 72(1). p.125-134- Abstract
Background: Current guidelines recommend androgen deprivation therapy only for men with very high-risk prostate cancer (PCa), but there is little evidence to support this stance. Objective: To investigate the association between radical local treatment and mortality in men with very high-risk PCa. Design, setting, and participants: Semiecologic study of men aged <80 yr within the Prostate Cancer data Base Sweden, diagnosed in 1998-2012 with very high-risk PCa (local clinical stage T4 and/or prostate-specific antigen [PSA] level 50-200. ng/ml, any N, and M0). Men with locally advanced PCa (local clinical stage T3 and PSA level <50. ng/ml, any N, and M0) were used as positive controls. Intervention: Proportion of men who received... (More)
Background: Current guidelines recommend androgen deprivation therapy only for men with very high-risk prostate cancer (PCa), but there is little evidence to support this stance. Objective: To investigate the association between radical local treatment and mortality in men with very high-risk PCa. Design, setting, and participants: Semiecologic study of men aged <80 yr within the Prostate Cancer data Base Sweden, diagnosed in 1998-2012 with very high-risk PCa (local clinical stage T4 and/or prostate-specific antigen [PSA] level 50-200. ng/ml, any N, and M0). Men with locally advanced PCa (local clinical stage T3 and PSA level <50. ng/ml, any N, and M0) were used as positive controls. Intervention: Proportion of men who received prostatectomy or full-dose radiotherapy in 640 experimental units defined by county, diagnostic period, and age at diagnosis. Outcome measurements and statistical analysis: PCa and all-cause mortality rate ratios (MRRs). Results and limitations: Both PCa and all-cause mortality were half as high in units in the highest tertile of exposure to radical local treatment compared with units in the lowest tertile (PCa MRR: 0.51; 95% confidence interval [CI], 0.28-0.95; and all-cause MRR: 0.56; 95% CI, 0.33-0.92). The results observed for locally advanced PCa for highest versus lowest tertile of exposure were in agreement with results from randomized trials (PCa MRR: 0.75; 95% CI, 0.60-0.94; and all-cause MRR: 0.85; 95% CI, 0.72-1.00). Although the semiecologic design minimized selection bias on an individual level, the effect of high therapeutic activity could not be separated from that of high diagnostic activity. Conclusions: The substantially lower mortality in units with the highest exposure to radical local treatment suggests that radical treatment decreases mortality even in men with very high-risk PCa for whom such treatment has been considered ineffective. Patient summary: Men with very high-risk prostate cancer diagnosed and treated in units with the highest exposure to surgery or radiotherapy had a substantially lower mortality. The cause-specific and all-cause mortality among men diagnosed with very high-risk prostate cancer in experimental units with high use of radical local treatment were half the rates of men diagnosed in experimental units with low use.
(Less)
- author
- Stattin, Pär ; Sandin, Fredrik ; Thomsen, Frederik Birkebæk ; Garmo, Hans ; Robinson, David ; Lissbrant, Ingela Franck ; Jonsson, Håkan LU and Bratt, Ola LU
- organization
- publishing date
- 2017-07
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Nationwide, PCBaSe, Population-based, Prostate cancer, Radical, Semiecologic, Treatment, Very high-risk
- in
- European Urology
- volume
- 72
- issue
- 1
- pages
- 125 - 134
- publisher
- Elsevier
- external identifiers
-
- pmid:27481175
- wos:000403205900026
- scopus:84997207163
- ISSN
- 0302-2838
- DOI
- 10.1016/j.eururo.2016.07.023
- language
- English
- LU publication?
- yes
- id
- 333030ba-a9a8-4814-bbe5-b1e63c03ac17
- date added to LUP
- 2016-12-30 14:17:25
- date last changed
- 2024-05-03 17:30:55
@article{333030ba-a9a8-4814-bbe5-b1e63c03ac17,
abstract = {{<p>Background: Current guidelines recommend androgen deprivation therapy only for men with very high-risk prostate cancer (PCa), but there is little evidence to support this stance. Objective: To investigate the association between radical local treatment and mortality in men with very high-risk PCa. Design, setting, and participants: Semiecologic study of men aged <80 yr within the Prostate Cancer data Base Sweden, diagnosed in 1998-2012 with very high-risk PCa (local clinical stage T4 and/or prostate-specific antigen [PSA] level 50-200. ng/ml, any N, and M0). Men with locally advanced PCa (local clinical stage T3 and PSA level <50. ng/ml, any N, and M0) were used as positive controls. Intervention: Proportion of men who received prostatectomy or full-dose radiotherapy in 640 experimental units defined by county, diagnostic period, and age at diagnosis. Outcome measurements and statistical analysis: PCa and all-cause mortality rate ratios (MRRs). Results and limitations: Both PCa and all-cause mortality were half as high in units in the highest tertile of exposure to radical local treatment compared with units in the lowest tertile (PCa MRR: 0.51; 95% confidence interval [CI], 0.28-0.95; and all-cause MRR: 0.56; 95% CI, 0.33-0.92). The results observed for locally advanced PCa for highest versus lowest tertile of exposure were in agreement with results from randomized trials (PCa MRR: 0.75; 95% CI, 0.60-0.94; and all-cause MRR: 0.85; 95% CI, 0.72-1.00). Although the semiecologic design minimized selection bias on an individual level, the effect of high therapeutic activity could not be separated from that of high diagnostic activity. Conclusions: The substantially lower mortality in units with the highest exposure to radical local treatment suggests that radical treatment decreases mortality even in men with very high-risk PCa for whom such treatment has been considered ineffective. Patient summary: Men with very high-risk prostate cancer diagnosed and treated in units with the highest exposure to surgery or radiotherapy had a substantially lower mortality. The cause-specific and all-cause mortality among men diagnosed with very high-risk prostate cancer in experimental units with high use of radical local treatment were half the rates of men diagnosed in experimental units with low use.</p>}},
author = {{Stattin, Pär and Sandin, Fredrik and Thomsen, Frederik Birkebæk and Garmo, Hans and Robinson, David and Lissbrant, Ingela Franck and Jonsson, Håkan and Bratt, Ola}},
issn = {{0302-2838}},
keywords = {{Nationwide; PCBaSe; Population-based; Prostate cancer; Radical; Semiecologic; Treatment; Very high-risk}},
language = {{eng}},
number = {{1}},
pages = {{125--134}},
publisher = {{Elsevier}},
series = {{European Urology}},
title = {{Association of Radical Local Treatment with Mortality in Men with Very High-risk Prostate Cancer : A Semiecologic, Nationwide, Population-based Study}},
url = {{http://dx.doi.org/10.1016/j.eururo.2016.07.023}},
doi = {{10.1016/j.eururo.2016.07.023}},
volume = {{72}},
year = {{2017}},
}