Authors: Gandaglia G, Sun M, Trinh QD, Becker A, Schiffmann J, Hu JC, Briganti A, Montorsi F, Perrotte P, Karakiewicz PI, Abdollah F
Title: Survival benefit of definitive therapy in patients with clinically advanced prostate cancer: estimations of the number needed to treat based on competing-risks analysis.
Journal: BJU Int :-
Date: 2014 Jan 27
Abstract: OBJECTIVE: To describe the survival benefit associated with radical prostatectomy (RP), as compared to initial observation, in patients with locally advanced prostate cancer (PCa). PATIENTS AND METHODS: Overall, 1,382 patients with locally advanced PCa treated with RP or initial observation between 1995 and 2009 within the Surveillance, Epidemiology, and End Results (SEER)-Medicare were identified. Patients were matched using propensity-score methodology. Ten-year cancer-specific mortality (CSM) rates were estimated, and the number needed to treat (NNT) was calculated. Competing-risks regression analyses tested the relationship between treatment type and CSM. RESULTS: Overall, the 10-year CSM rates were 11.8 vs. 19.3% for patients treated with RP vs. observation, respectively (P<0.001). The corresponding 10-year NNT was 13. The 10-year CSM rates for the same respective treatment groups were 8.9 vs. 13.9% for Gleason score ≤7, 16.8 vs. 27.8% for Gleason score 8-10, 10.1 vs. 15.8% for clinical stage T3a, and 17.0 vs. 29.3% for T3b/T4, respectively (all P≤0.04). The corresponding NNTs were 20, 9, 17, and 8, respectively. In multivariable analyses, RP was an independent predictor of more favorable CSM in all categories (all P≤0.04). In separate sensitivity analyses, no differences were recorded when patients treated with radiotherapy were compared with those receiving RP (P=0.4). Conversely, patients undergoing initial observation had higher risk of CSM compared to those treated with radiotherapy (P=0.03). CONCLUSIONS: RP leads to a significant survival advantage compared to observation in patients with locally advanced disease. The highest benefit was observed in patients with T3b/T4 and Gleason score 8-10 disease.
Last Modified: 03 Sep 2013