Radical prostatectomy or radiotherapy for high- and very high-risk prostate cancer: a multidisciplinary prostate cancer clinic experience of patients eligible for either treatment

Chad A. Reichard, Karen E. Hoffman, Chad Tang, Stephen Williams, Pamela K. Allen, Mary F. Achim, Deborah A. Kuban, Brian F. Chapin

    Research output: Contribution to journalArticle

    1 Citation (Scopus)

    Abstract

    Objective: To compare radical prostatectomy (RP) vs radiotherapy (RT) with androgen-deprivation therapy (ADT) in the setting of patients with high-risk and very high-risk (VHR) prostate cancer who were deemed eligible for either therapy and made a treatment choice after consultation in a multidisciplinary prostate cancer clinic (MDPCC), and to compare the MDPCC patients’ outcomes to a matched Surveillance, Epidemiology and End Results (SEER) cohort. Patients and methods: Prospectively collected, retrospective study comparing patients who underwent RP (231 patients) vs RT+ADT (73) from 2004 to 2013. Biochemical recurrence (BCR), local recurrence, distant metastasis failure, and overall survival (OS) were calculated for each treatment group overall and according to National Comprehensive Cancer Network risk strata. A propensity score matched comparison with a SEER cohort was performed for OS. Results: There was no difference in local recurrence (hazard ratio [HR] 2.7, 95% confidence interval [CI] 1.0–7.9; P = 0.06), distant metastasis failure (HR 2.5, 95% CI 0.8–7.8; P = 0.1) and OS (HR 1.35, 95% CI 0.4–4.8; P = 0.6) between patients undergoing RP vs RT+ADT. Patients treated via the MDPCC survived on average 16.9 months (95% CI 13.1–20.8) longer than those in the matched SEER cohort. Conclusions: Long-term outcomes appear similar amongst patients with high-risk and VHR prostate cancer deemed eligible for either RP or RT, and treated after consultation in a MDPCC. Outcomes of the MDPCC patients were superior to those of the matched SEER cohort.

    Original languageEnglish (US)
    JournalBJU International
    DOIs
    StatePublished - Jan 1 2019

    Fingerprint

    Prostatectomy
    Prostatic Neoplasms
    Radiotherapy
    Epidemiology
    Confidence Intervals
    Androgens
    Therapeutics
    Recurrence
    Survival
    Referral and Consultation
    Neoplasm Metastasis
    Propensity Score
    Retrospective Studies

    Keywords

    • #PCSM
    • #ProstateCancer
    • high risk
    • multidisciplinary
    • radical prostatectomy
    • radiotherapy

    ASJC Scopus subject areas

    • Urology

    Cite this

    Radical prostatectomy or radiotherapy for high- and very high-risk prostate cancer : a multidisciplinary prostate cancer clinic experience of patients eligible for either treatment. / Reichard, Chad A.; Hoffman, Karen E.; Tang, Chad; Williams, Stephen; Allen, Pamela K.; Achim, Mary F.; Kuban, Deborah A.; Chapin, Brian F.

    In: BJU International, 01.01.2019.

    Research output: Contribution to journalArticle

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    title = "Radical prostatectomy or radiotherapy for high- and very high-risk prostate cancer: a multidisciplinary prostate cancer clinic experience of patients eligible for either treatment",
    abstract = "Objective: To compare radical prostatectomy (RP) vs radiotherapy (RT) with androgen-deprivation therapy (ADT) in the setting of patients with high-risk and very high-risk (VHR) prostate cancer who were deemed eligible for either therapy and made a treatment choice after consultation in a multidisciplinary prostate cancer clinic (MDPCC), and to compare the MDPCC patients’ outcomes to a matched Surveillance, Epidemiology and End Results (SEER) cohort. Patients and methods: Prospectively collected, retrospective study comparing patients who underwent RP (231 patients) vs RT+ADT (73) from 2004 to 2013. Biochemical recurrence (BCR), local recurrence, distant metastasis failure, and overall survival (OS) were calculated for each treatment group overall and according to National Comprehensive Cancer Network risk strata. A propensity score matched comparison with a SEER cohort was performed for OS. Results: There was no difference in local recurrence (hazard ratio [HR] 2.7, 95{\%} confidence interval [CI] 1.0–7.9; P = 0.06), distant metastasis failure (HR 2.5, 95{\%} CI 0.8–7.8; P = 0.1) and OS (HR 1.35, 95{\%} CI 0.4–4.8; P = 0.6) between patients undergoing RP vs RT+ADT. Patients treated via the MDPCC survived on average 16.9 months (95{\%} CI 13.1–20.8) longer than those in the matched SEER cohort. Conclusions: Long-term outcomes appear similar amongst patients with high-risk and VHR prostate cancer deemed eligible for either RP or RT, and treated after consultation in a MDPCC. Outcomes of the MDPCC patients were superior to those of the matched SEER cohort.",
    keywords = "#PCSM, #ProstateCancer, high risk, multidisciplinary, radical prostatectomy, radiotherapy",
    author = "Reichard, {Chad A.} and Hoffman, {Karen E.} and Chad Tang and Stephen Williams and Allen, {Pamela K.} and Achim, {Mary F.} and Kuban, {Deborah A.} and Chapin, {Brian F.}",
    year = "2019",
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    doi = "10.1111/bju.14780",
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    T1 - Radical prostatectomy or radiotherapy for high- and very high-risk prostate cancer

    T2 - a multidisciplinary prostate cancer clinic experience of patients eligible for either treatment

    AU - Reichard, Chad A.

    AU - Hoffman, Karen E.

    AU - Tang, Chad

    AU - Williams, Stephen

    AU - Allen, Pamela K.

    AU - Achim, Mary F.

    AU - Kuban, Deborah A.

    AU - Chapin, Brian F.

    PY - 2019/1/1

    Y1 - 2019/1/1

    N2 - Objective: To compare radical prostatectomy (RP) vs radiotherapy (RT) with androgen-deprivation therapy (ADT) in the setting of patients with high-risk and very high-risk (VHR) prostate cancer who were deemed eligible for either therapy and made a treatment choice after consultation in a multidisciplinary prostate cancer clinic (MDPCC), and to compare the MDPCC patients’ outcomes to a matched Surveillance, Epidemiology and End Results (SEER) cohort. Patients and methods: Prospectively collected, retrospective study comparing patients who underwent RP (231 patients) vs RT+ADT (73) from 2004 to 2013. Biochemical recurrence (BCR), local recurrence, distant metastasis failure, and overall survival (OS) were calculated for each treatment group overall and according to National Comprehensive Cancer Network risk strata. A propensity score matched comparison with a SEER cohort was performed for OS. Results: There was no difference in local recurrence (hazard ratio [HR] 2.7, 95% confidence interval [CI] 1.0–7.9; P = 0.06), distant metastasis failure (HR 2.5, 95% CI 0.8–7.8; P = 0.1) and OS (HR 1.35, 95% CI 0.4–4.8; P = 0.6) between patients undergoing RP vs RT+ADT. Patients treated via the MDPCC survived on average 16.9 months (95% CI 13.1–20.8) longer than those in the matched SEER cohort. Conclusions: Long-term outcomes appear similar amongst patients with high-risk and VHR prostate cancer deemed eligible for either RP or RT, and treated after consultation in a MDPCC. Outcomes of the MDPCC patients were superior to those of the matched SEER cohort.

    AB - Objective: To compare radical prostatectomy (RP) vs radiotherapy (RT) with androgen-deprivation therapy (ADT) in the setting of patients with high-risk and very high-risk (VHR) prostate cancer who were deemed eligible for either therapy and made a treatment choice after consultation in a multidisciplinary prostate cancer clinic (MDPCC), and to compare the MDPCC patients’ outcomes to a matched Surveillance, Epidemiology and End Results (SEER) cohort. Patients and methods: Prospectively collected, retrospective study comparing patients who underwent RP (231 patients) vs RT+ADT (73) from 2004 to 2013. Biochemical recurrence (BCR), local recurrence, distant metastasis failure, and overall survival (OS) were calculated for each treatment group overall and according to National Comprehensive Cancer Network risk strata. A propensity score matched comparison with a SEER cohort was performed for OS. Results: There was no difference in local recurrence (hazard ratio [HR] 2.7, 95% confidence interval [CI] 1.0–7.9; P = 0.06), distant metastasis failure (HR 2.5, 95% CI 0.8–7.8; P = 0.1) and OS (HR 1.35, 95% CI 0.4–4.8; P = 0.6) between patients undergoing RP vs RT+ADT. Patients treated via the MDPCC survived on average 16.9 months (95% CI 13.1–20.8) longer than those in the matched SEER cohort. Conclusions: Long-term outcomes appear similar amongst patients with high-risk and VHR prostate cancer deemed eligible for either RP or RT, and treated after consultation in a MDPCC. Outcomes of the MDPCC patients were superior to those of the matched SEER cohort.

    KW - #PCSM

    KW - #ProstateCancer

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    KW - multidisciplinary

    KW - radical prostatectomy

    KW - radiotherapy

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    DO - 10.1111/bju.14780

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