Abstract
Objective
To evaluate the comparative effectiveness of local vs systemic therapy among patients
diagnosed with nonmetastatic clinical T4 prostate cancer.
Methods
Using the National Cancer Database men with clinical T4N0-1M0 prostate cancer from
2004 to 2013 were identified. Local therapy was defined as radiation (RT with androgen
deprivation therapy [ADT]), surgery (radical prostatectomy with ADT), or combined
radiation plus surgery (radical prostatectomy plus RT with ADT). Systemic therapy
was defined as ADT or chemotherapy alone. The primary outcome of overall survival
was estimated using the Kaplan-Meier method. Factors associated with overall survival
were determined by Cox proportional hazards models.
Results
A total of 1914 patients were included in our analysis, 1559 received local therapy
and 355 received systemic therapy. Median 5-year survival for local vs systemic therapy
was 41.5 and 28.2 months, respectively. On multivariable analysis, local therapy was
associated with increased overall survival compared to systemic therapy (hazard ratio
[HR] = 0.52; 95% confidence interval [CI] 0.44-0.62, P < .001). Comparing local therapy treatment modalities, both radiation (HR = 0.44;
95% CI 0.36-0.53, P < .001) and surgery (HR = 0.67; 95% CI 0.55-0.82, P < .001) were associated with increased overall survival compared to systemic therapy.
Among those receiving local therapy, more patients were treated with radiation (n = 709/1559
or 45.5%) compared to surgery (n = 560/1559 or 35.9%) or combined radiation plus surgery
(n = 290/1559 or 18.6%) with 5-year overall survival by treatment type being 61%,
51.4%, and 62.2%, respectively.
Conclusion
Local therapy for clinical T4 prostate cancer is associated with improved overall
survival. Due to the retrospective, nonrandomized nature of the study design, a clinical
trial is needed to better define the efficacy of local therapy in this high-risk patient
population.
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Article info
Publication history
Published online: July 07, 2018
Accepted:
June 27,
2018
Received in revised form:
June 8,
2018
Received:
April 10,
2018
Footnotes
☆Disclosures: The authors declare that they have no relevant financial interests.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
