345 476
Platinum Priority – Prostate Cancer
Editorial by Chad A. Reichard and Brian F. Chapin on pp. 352–353 of this issue
Survival Among Men at High Risk of Disseminated Prostate Cancer
Receiving Initial Locally Directed Radical Treatment or Initial
Androgen Deprivation Therapy
Prasanna Sooriakumaran
a , b , c ,Tommy Nyberg
d[1_TD$DIFF]
, e ,Olof Akre
f[1_TD$DIFF]
,[1_TD$DIFF]
Anders Widmark
g ,Freddie Hamdy
c[1_TD$DIFF]
,[1_TD$DIFF]
Markus Graefen
i[2_TD$DIFF]
,Stefan Carlsson
b ,Gunnar Steineck
d[1_TD$DIFF]
, h ,N. Peter Wiklund
b[1_TD$DIFF]
, *[1_TD$DIFF]
a
Department of Urology, University College London Hospital, London, UK;
b
Department of Molecular Medicine & Surgery, Karolinska Institutet, Stockholm,
Sweden;
c
Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK;
d
Clinical Cancer Epidemiology, Department of Oncology-Pathology,
Karolinska Institutet, Stockholm, Sweden;
e
Centre for Cancer Centre Epidemiology, Department of Public Health and Primary Care, University of Cambridge,
Cambridge, UK;
f
Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden;
g
Department of Radiation Sciences, Umea
University, Umea, Sweden;
h
Clinical Cancer Epidemiology, Department of Oncology, Gothenburg University, Gothenburg, Sweden;
i
Martini Clinic, Prostate
Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
E U R O P E A N U R O L O G Y 7 2 ( 2 0 1 7 ) 3 4 5 – 3 5 1ava ilable at
www.sciencedirect.comjournal homepage:
www.eu ropeanurology.comArticle info
Article history:
Accepted April 4, 2017
Associate Editor:
Giacomo Novara
Keywords:
Prostate cancer
Disseminated
Radical therapy
Radiation
Surgery
Abstract
Background:
There is increasing low-quality evidence rationalizing the use of radical therapy
for men at high risk of disseminated prostate cancer.
Objective:
To investigate, using high-quality epidemiologic data, whether initial radical
therapy in men at high risk of disseminated prostate cancer improves survival.
Design, setting, and participants:
An observational population-based Swedish study from
1996 to 2010 of men at high risk of disseminated prostate cancer (prostate-specific antigen
[PSA]
>
50) initially treated by radical therapy (radiation therapy [
n
= 630] or radical prosta-
tectomy [
n
= 120]) or androgen deprivation therapy (
n
= 17 602), and followed for up to 15 yr.
Outcome measurements and statistical analysis:
Prostate-cancer and other-cause mortality
was estimated for the treatment groups. We also matched the two cohorts for grade, T stage, M
stage, Charlson score, year of diagnosis, age, and PSA, and found androgen deprivation therapy
patient matches for 575 of the radical therapy patients, and then repeated comparative
effectiveness analyses.
Results and limitation:
Prostate-cancer mortality was substantially greater in the androgen
deprivation therapy group comparedwith the radically treated one, in unmatched (9062/17 602
vs 86/750) and matched (177/575 vs 71/575) cohorts. Among matched cohorts, initial androgen
deprivation therapy was associated with nearly three-fold higher hazard of prostate-cancer
death compared with initial radical therapy (2.87; 95% confidence interval 2.16–3.82). Multiple
sensitivity analyses suggested that the findings were robust, although the general limitations of
nonrandomized studies remain. Further, the study cohort may have included men with both
systemic and nonsystemic disease, as a sole eligibility criterion of PSA
>
50 was used.
Conclusions:
This large and comprehensive population-based study suggests that initial
radical therapy in men at high risk of disseminated prostate cancer improves survival.
Patient summary:
This large Swedish study suggests that men with prostate cancer that has
spread beyond the prostate benefit from treating the prostate itself with radiation therapy or
surgery rather than treating the disease with hormones alone.
#
2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.
* Corresponding author. Department of Molecular Medicine & Surgery, Karolinska Institutet, Stock-
holm, Sweden. Tel. +46 739660771.
E-mail address:
peter.wiklund@karolinska.se(N.P. Wiklund).
http://dx.doi.org/10.1016/j.eururo.2017.04.0020302-2838/
#
2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.