Open Access

ARTICLE

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

Rachael Sussman^1,2,*, Filipe L.F. Carvalho^1,2,*, Andrew Harbin¹, Choayi Zheng¹, John H. Lynch¹, Lambros Stamatakis², Jonathan Hwang², Stephen B. Williams³, Jim C. Hu⁴, Keith J. Kowalczyk¹

1 Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
2 Department of Urology, MedStar Washington Hospital Center, Washington, DC, USA
3 Division of Urology, The University of Texas Medical Branch, Galveston, Texas, USA
4 Department of Urology, Weill Cornell Medical College, New York New York, USA
* authors contributed equally
Address correspondence to Dr. Filipe L.F. Carvalho, Department of Urology, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, 1PHC, Washington DC, 20007 USA

Canadian Journal of Urology 2018, 25(5), 9516-9524.

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 post-treatment 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-person-years, 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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