Survival and secondary interventions following treatment for locally-advanced prostate cancer

Rachael Sussman, Filipe L.F. Carvalho, Andrew Harbin, Choayi Zheng, John H. Lynch, Lambros Stamatakis, Jonathan Hwang, Stephen Williams, Jim C. Hu, Keith J. Kowalczyk

    Research output: Contribution to journalArticle

    Abstract

    Introduction: The utility of radical prostatectomy (RP) for locally-advanced prostate cancer remains unknown. Retrospective data has shown equivalent oncologic outcomes compared to radiation therapy (RT). RP may provide local tumor control and prevent secondary interventions from local invasion, and may decrease costs. Materials and methods: Using SEER-Medicare data from 1995-2011 we identified men with locally-advanced prostate cancer undergoing RP or RT. Rates of posttreatment diagnoses and interventions were identified using ICD-9 and CPT codes. Skeletal related events (SRE), androgen deprivation therapy (ADT) utilization, all-cause mortality, prostate cancer-specific mortality, and costs were compared. Results: A total of 8367 men with locally-advanced prostate cancer were identified (6200 RP, 2167 RT). RT was associated with increased urinary obstruction, hematuria, infection, and cystoscopic intervention while RP was associated with increased urethral stricture intervention and erectile dysfunction. Compared to RT, RP was associated with decreased all-cause mortality (3.1 versus 5.2 deaths/100- person-years, p < 0.001), prostate cancer-specific mortality (0.8 versus 2.0 deaths/100-person-years, p < 0.001), SREs (2.0 versus 3.4 events/100 person-years, p < 0.001), and ADT utilization overall (7.4 versus 33.8 doses/100-personyears, p < 0.001) and > 3 years after treatment (3.6 versus 4.6 doses/100-person-years, p < 0.001). Overall and cancer specific costs were significantly lower for RP versus RT. Conclusions: RT for locally-advanced prostate cancer has a higher incidence of mortality, secondary diagnoses and interventions, SRE, and ADT utilization compared to RP. This may lead to increased costs and have implications for quality of life. Our findings support the utility of RP in appropriately selected men with locally-advanced prostate cancer given the possible decreased morbidity and survival benefit.

    Original languageEnglish (US)
    Pages (from-to)9515-9524
    Number of pages10
    JournalCanadian Journal of Urology
    Volume25
    Issue number5
    StatePublished - Oct 1 2018

    Fingerprint

    Prostatectomy
    Prostatic Neoplasms
    Radiotherapy
    Survival
    Costs and Cost Analysis
    Therapeutics
    Mortality
    International Classification of Diseases
    Androgens
    Current Procedural Terminology
    Urethral Stricture
    Hematuria
    Erectile Dysfunction
    Medicare
    Neoplasms
    Quality of Life
    Morbidity
    Incidence
    Infection

    Keywords

    • Prostate cancer
    • Radiation therapy
    • Radical prostatectomy
    • SEER-Medicare

    ASJC Scopus subject areas

    • Urology

    Cite this

    Sussman, R., Carvalho, F. L. F., Harbin, A., Zheng, C., Lynch, J. H., Stamatakis, L., ... Kowalczyk, K. J. (2018). Survival and secondary interventions following treatment for locally-advanced prostate cancer. Canadian Journal of Urology, 25(5), 9515-9524.

    Survival and secondary interventions following treatment for locally-advanced prostate cancer. / Sussman, Rachael; Carvalho, Filipe L.F.; Harbin, Andrew; Zheng, Choayi; Lynch, John H.; Stamatakis, Lambros; Hwang, Jonathan; Williams, Stephen; Hu, Jim C.; Kowalczyk, Keith J.

    In: Canadian Journal of Urology, Vol. 25, No. 5, 01.10.2018, p. 9515-9524.

    Research output: Contribution to journalArticle

    Sussman, R, Carvalho, FLF, Harbin, A, Zheng, C, Lynch, JH, Stamatakis, L, Hwang, J, Williams, S, Hu, JC & Kowalczyk, KJ 2018, 'Survival and secondary interventions following treatment for locally-advanced prostate cancer', Canadian Journal of Urology, vol. 25, no. 5, pp. 9515-9524.
    Sussman R, Carvalho FLF, Harbin A, Zheng C, Lynch JH, Stamatakis L et al. Survival and secondary interventions following treatment for locally-advanced prostate cancer. Canadian Journal of Urology. 2018 Oct 1;25(5):9515-9524.
    Sussman, Rachael ; Carvalho, Filipe L.F. ; Harbin, Andrew ; Zheng, Choayi ; Lynch, John H. ; Stamatakis, Lambros ; Hwang, Jonathan ; Williams, Stephen ; Hu, Jim C. ; Kowalczyk, Keith J. / Survival and secondary interventions following treatment for locally-advanced prostate cancer. In: Canadian Journal of Urology. 2018 ; Vol. 25, No. 5. pp. 9515-9524.
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    abstract = "Introduction: The utility of radical prostatectomy (RP) for locally-advanced prostate cancer remains unknown. Retrospective data has shown equivalent oncologic outcomes compared to radiation therapy (RT). RP may provide local tumor control and prevent secondary interventions from local invasion, and may decrease costs. Materials and methods: Using SEER-Medicare data from 1995-2011 we identified men with locally-advanced prostate cancer undergoing RP or RT. Rates of posttreatment diagnoses and interventions were identified using ICD-9 and CPT codes. Skeletal related events (SRE), androgen deprivation therapy (ADT) utilization, all-cause mortality, prostate cancer-specific mortality, and costs were compared. Results: A total of 8367 men with locally-advanced prostate cancer were identified (6200 RP, 2167 RT). RT was associated with increased urinary obstruction, hematuria, infection, and cystoscopic intervention while RP was associated with increased urethral stricture intervention and erectile dysfunction. Compared to RT, RP was associated with decreased all-cause mortality (3.1 versus 5.2 deaths/100- person-years, p < 0.001), prostate cancer-specific mortality (0.8 versus 2.0 deaths/100-person-years, p < 0.001), SREs (2.0 versus 3.4 events/100 person-years, p < 0.001), and ADT utilization overall (7.4 versus 33.8 doses/100-personyears, p < 0.001) and > 3 years after treatment (3.6 versus 4.6 doses/100-person-years, p < 0.001). Overall and cancer specific costs were significantly lower for RP versus RT. Conclusions: RT for locally-advanced prostate cancer has a higher incidence of mortality, secondary diagnoses and interventions, SRE, and ADT utilization compared to RP. This may lead to increased costs and have implications for quality of life. Our findings support the utility of RP in appropriately selected men with locally-advanced prostate cancer given the possible decreased morbidity and survival benefit.",
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    T1 - Survival and secondary interventions following treatment for locally-advanced prostate cancer

    AU - Sussman, Rachael

    AU - Carvalho, Filipe L.F.

    AU - Harbin, Andrew

    AU - Zheng, Choayi

    AU - Lynch, John H.

    AU - Stamatakis, Lambros

    AU - Hwang, Jonathan

    AU - Williams, Stephen

    AU - Hu, Jim C.

    AU - Kowalczyk, Keith J.

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    N2 - Introduction: The utility of radical prostatectomy (RP) for locally-advanced prostate cancer remains unknown. Retrospective data has shown equivalent oncologic outcomes compared to radiation therapy (RT). RP may provide local tumor control and prevent secondary interventions from local invasion, and may decrease costs. Materials and methods: Using SEER-Medicare data from 1995-2011 we identified men with locally-advanced prostate cancer undergoing RP or RT. Rates of posttreatment diagnoses and interventions were identified using ICD-9 and CPT codes. Skeletal related events (SRE), androgen deprivation therapy (ADT) utilization, all-cause mortality, prostate cancer-specific mortality, and costs were compared. Results: A total of 8367 men with locally-advanced prostate cancer were identified (6200 RP, 2167 RT). RT was associated with increased urinary obstruction, hematuria, infection, and cystoscopic intervention while RP was associated with increased urethral stricture intervention and erectile dysfunction. Compared to RT, RP was associated with decreased all-cause mortality (3.1 versus 5.2 deaths/100- person-years, p < 0.001), prostate cancer-specific mortality (0.8 versus 2.0 deaths/100-person-years, p < 0.001), SREs (2.0 versus 3.4 events/100 person-years, p < 0.001), and ADT utilization overall (7.4 versus 33.8 doses/100-personyears, p < 0.001) and > 3 years after treatment (3.6 versus 4.6 doses/100-person-years, p < 0.001). Overall and cancer specific costs were significantly lower for RP versus RT. Conclusions: RT for locally-advanced prostate cancer has a higher incidence of mortality, secondary diagnoses and interventions, SRE, and ADT utilization compared to RP. This may lead to increased costs and have implications for quality of life. Our findings support the utility of RP in appropriately selected men with locally-advanced prostate cancer given the possible decreased morbidity and survival benefit.

    AB - Introduction: The utility of radical prostatectomy (RP) for locally-advanced prostate cancer remains unknown. Retrospective data has shown equivalent oncologic outcomes compared to radiation therapy (RT). RP may provide local tumor control and prevent secondary interventions from local invasion, and may decrease costs. Materials and methods: Using SEER-Medicare data from 1995-2011 we identified men with locally-advanced prostate cancer undergoing RP or RT. Rates of posttreatment diagnoses and interventions were identified using ICD-9 and CPT codes. Skeletal related events (SRE), androgen deprivation therapy (ADT) utilization, all-cause mortality, prostate cancer-specific mortality, and costs were compared. Results: A total of 8367 men with locally-advanced prostate cancer were identified (6200 RP, 2167 RT). RT was associated with increased urinary obstruction, hematuria, infection, and cystoscopic intervention while RP was associated with increased urethral stricture intervention and erectile dysfunction. Compared to RT, RP was associated with decreased all-cause mortality (3.1 versus 5.2 deaths/100- person-years, p < 0.001), prostate cancer-specific mortality (0.8 versus 2.0 deaths/100-person-years, p < 0.001), SREs (2.0 versus 3.4 events/100 person-years, p < 0.001), and ADT utilization overall (7.4 versus 33.8 doses/100-personyears, p < 0.001) and > 3 years after treatment (3.6 versus 4.6 doses/100-person-years, p < 0.001). Overall and cancer specific costs were significantly lower for RP versus RT. Conclusions: RT for locally-advanced prostate cancer has a higher incidence of mortality, secondary diagnoses and interventions, SRE, and ADT utilization compared to RP. This may lead to increased costs and have implications for quality of life. Our findings support the utility of RP in appropriately selected men with locally-advanced prostate cancer given the possible decreased morbidity and survival benefit.

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