Association between Radical Prostatectomy and Survival in Men with Clinically Node-positive Prostate Cancer
| Autor: | Rana R. McKay, Stephen Ryan, Reith R Sarkar, Alex K. Bryant, Brent S. Rose, James D. Murphy, Ajay Sandhu, Christopher J. Kane, A. Karim Kader, J. Kellogg Parsons |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Aging Time Factors medicine.medical_treatment 030232 urology & nephrology law.invention Androgen deprivation therapy Prostate cancer 0302 clinical medicine Randomized controlled trial law Adjuvant Cancer Prostatectomy Prostate Multimodal therapy Chemoradiotherapy Middle Aged Radical prostatectomy Neoadjuvant Therapy prostate cancer-specific mortality Treatment Outcome Oncology Chemotherapy Adjuvant 030220 oncology & carcinogenesis Lymphatic Metastasis Patient Safety 6.4 Surgery Urologic Diseases medicine.medical_specialty Urology Clinical Trials and Supportive Activities Article 03 medical and health sciences Clinical Research medicine Humans Chemotherapy Radiology Nuclear Medicine and imaging Clinically node-positive Aged Proportional hazards model business.industry Prostatic Neoplasms Evaluation of treatments and therapeutic interventions Androgen Antagonists medicine.disease Survival Analysis Confidence interval Radiation therapy Good Health and Well Being Lymph Node Excision Surgery Lymph Nodes Neoplasm Grading business prostate cancer–specific mortality |
| Zdroj: | European urology oncology, vol 2, iss 5 Eur Urol Oncol |
| Popis: | Evidence supporting radical prostatectomy (RP) for men with clinically node-positive (cN+) prostate cancer (PC) is limited. In a US national database, we identified 741 men with cN+ nonmetastatic PC diagnosed during 2000–2015 who underwent definitive local therapy with RP (n = 78), radiotherapy (RT) with neoadjuvant androgen deprivation therapy (ADT) (n = 193), or nondefinitive therapy with ADT alone (n = 445) or observation (n=25). We compared PC-specific mortality (PCSM) and all-cause mortality (ACM) using multivariable Fine-Gray competing risk regression and Cox regression, respectively. Compared to nondefinitive therapy, RP was associated with significantly better PCSM (subdistribution hazard ratio [SHR] 0.32, 95% confidence interval [CI] 0.16–0.66; p = 0.002) and ACM (HR 0.36, 95% CI 0.21–0.61; p < 0.001). Compared to RT, RP was not associated with a significant difference in PCSM (SHR 0.47, 95% CI 0.19–1.17; p = 0.1) or ACM (HR 0.88, 95% CI 0.46–1.70; p = 0.71). These data suggest that RP is associated with favorable survival outcomes that appear to be superior to those for patients who did not receive definitive therapy and comparable to those for patients receiving definitive ADT/RT. Randomized trials of surgery with multimodal therapy are needed. PATIENT SUMMARY: We found that in clinically node-positive prostate cancer, radical prostatectomy was associated with a cancer-specific and overall survival benefit compared to nondefinitive therapy. Randomized clinical trials are required to determine the best treatment approach in this patient population. |
| Databáze: | OpenAIRE |
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