Dataset Information

Superior metastasis-free survival for patients with high-risk prostate cancer treated with definitive radiation therapy compared to radical prostatectomy: A propensity score-matched analysis.

ABSTRACT:

Purpose

For high-risk prostate cancer (HR-PCa) in men with a life expectancy of at least 10 years, the National Comprehensive Cancer Network recommends radiation therapy (RT) plus androgen deprivation therapy (ADT) with category 1 evidence or radical prostatectomy (RP) as an acceptable initial therapy. Randomized evidence regarding which therapy is optimal for disease control is lacking for men with HR-PCa. We performed a propensity-score-matched comparison of outcomes for men with localized HR-PCa treated with primary RT or RP.

Methods and materials

The medical records of patients with localized HR-PCa who were treated at our institution between 2002 and 2011 were reviewed. Patient and disease characteristics, treatment details, and outcomes were collected. A combination of nearest-neighbor propensity score matching on age, Adult Comorbidity Evaluation-27 comorbidity index, prostate-specific antigen, biopsy Gleason scores, and clinical T-stage as well as exact matching on prostate-specific antigen, biopsy Gleason scores, and clinical T-stage was performed. Outcomes were measured from diagnosis. Multivariate Cox proportional hazards regression was used to compare metastasis-free and overall survival.

Results

A total of 246 patients were identified with 62 propensity-score-matched pairs. ADT was administered to 6.5% and 80.6% of patients receiving RP and RT, respectively. Five-year rates of metastasis for RP and RT were 33% and 8.9%, respectively (P?=?.003). Overall survival was not different. Delay of salvage therapy was longer for patients undergoing primary RT (P?ConclusionsAt our institution, treatment with primary RT resulted in superior metastasis-free survival over RP. This was not accompanied by an improvement in OS.

SUBMITTER: Markovina S

PROVIDER: S-EPMC6000029 | biostudies-literature | 2018 Apr-Jun

REPOSITORIES: biostudies-literature

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Publications

Superior metastasis-free survival for patients with high-risk prostate cancer treated with definitive radiation therapy compared to radical prostatectomy: A propensity score-matched analysis.

Markovina Stephanie S Meeks Marshall W MW Badiyan Shahed S Vetter Joel J Gay Hiram A HA Paradis Alethea A Michalski Jeff J Sandhu Gurdarshan G

Advances in radiation oncology 20171213 2

<h4>Purpose</h4>For high-risk prostate cancer (HR-PCa) in men with a life expectancy of at least 10 years, the National Comprehensive Cancer Network recommends radiation therapy (RT) plus androgen deprivation therapy (ADT) with category 1 evidence or radical prostatectomy (RP) as an acceptable initial therapy. Randomized evidence regarding which therapy is optimal for disease control is lacking for men with HR-PCa. We performed a propensity-score-matched comparison of outcomes for men with local ...[more]

PMID: 29904744

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Project description:The da Vinci® single-port (SP) and multiport (Xi) approaches to robotic-assisted radical prostatectomy (RARP) are described by different authors in the literature, primarily comparing short-term outcomes of both modalities. To our knowledge, this is the first article comparing the surgical perspective and satisfaction of patients who underwent RARP with the SP and Xi platforms. To determine the patient surgical perspective and satisfaction in terms of pain control, return to normal activity, and overall results of surgery for two groups who underwent SP and Xi radical prostatectomy. The data from 71 consecutive patients who underwent SP RARP in a single center from June 2019 to April 2020 was compared to 875 patients who underwent Xi RARP in the same period. A single surgeon performed all procedures with a transperitoneal technique. After a propensity score match, two groups of 71 patients (SP and Xi) were selected and compared in the study. Patients were contacted by phone by two interviewers and a questionnaire was administered in English or Spanish. Patients were instructed not to disclose the type of robotic surgery they underwent, as interviewers were blinded to that information. A validated Surgical Satisfaction Questionnaire (SSQ-8) was used, along with an additional question from our institution asking about the satisfaction with the number of incision sites (GRI-1). Data were analyzed as continuous and discrete variables to compare the differences between the Xi and SP cohorts. A response rate of 85.9% (n = 61) in the Xi group and 73.2% (n = 52) in the SP group was captured. Overall satisfaction with surgical results was 80% and 88% in the Xi and SP cohorts, respectively. No statistical difference in responses was found between the Xi and SP cohorts for SSQ-8. However, GRI-1 demonstrated a statistically significant difference (P < 0.001) in terms of number of scars that favors the SP approach. Limitations of this study are the small sample size and recall bias. We found no statistical difference between the groups regarding the answers for SSQ-8 questionnaire; both groups were very satisfied. When assessing the number of incision sites with the GRI-1 question, patients who underwent MP had lower satisfaction rates compared to SP. These patients perceived the number of scars and their appearance as reason for lower satisfaction. We believe that future studies should consider patient's postoperative perspective when adopting new platforms in order to combine adequate treatment with patient expectations. We performed a study assessing the postoperative satisfaction and perspectives of two groups of patients who underwent radical prostatectomy with two different robots (SP and Xi). There was no difference in patient satisfaction with the results of either the da Vinci® SP or Xi RARP except for the patients' perception on their number of scars, which favored the SP group.

Dataset Information

Superior metastasis-free survival for patients with high-risk prostate cancer treated with definitive radiation therapy compared to radical prostatectomy: A propensity score-matched analysis.

Purpose

Methods and materials

Results

Publications

Superior metastasis-free survival for patients with high-risk prostate cancer treated with definitive radiation therapy compared to radical prostatectomy: A propensity score-matched analysis.

Similar Datasets

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