Localized prostate cancer: An analysis of the Centers for Disease Control and Prevention Breast and Prostate Cancer Data Quality and Patterns of Care study (CDC PoC-BP)

Authors

  • Kenan Celtik Department of Urology, Houston Methodist Hospital
  • Christopher J.D. Wallis Department of Urology, Vanderbilt University
  • Mary Lo Department of Preventive Medicine, USC Keck School of Medicine
  • Kelvin Lim Houston Methodist Hospital
  • Joseph Lipscomb Rollins School of Public Health and Winship Cancer Institute, Emory University
  • Steven Fleming College of Public Health, University of Kentucky
  • Xiao-Cheng Wu Louisiana Tumor Registry, LSUHSC: Louisiana State University Health Sciences Center
  • Roger T. Anderson Department of Public Health Sciences, University of Virginia
  • Trevor D. Thompson CDC: Centers for Disease Control and Prevention
  • Andrew Farach Department of Radiation Oncology, Houston Methodist Hospital
  • Ann S. Hamilton Department of Preventive Medicine, USC Keck School of Medicine
  • Brian J. Miles Department of Urology, Houston Methodist Hospital
  • Raj Satkunasivam Department of Urology, Houston Methodist Hospital; Center for Outcomes Research, Houston Methodist Hospital

DOI:

https://doi.org/10.5489/cuaj.7580

Keywords:

prostate cancer, radical prostatectomy, radiation therapy, survival, comorbidities, PoC-BP

Abstract

Introduction: Limited evidence exists on the comparative effectiveness of local treatments for prostate cancer (PCa) due to the lack of generalizability. Using granular national data, we sought to examine the association between radical prostatectomy (RP) and intensity-modulated radiation therapy (IMRT) treatment and survival.

Methods: Records were abstracted for localized PCa cases diagnosed in 2004 across seven state registries to identify patients undergoing RP (n=3019) or IMRT (n=667). Comorbidity was assessed by the Adult Comorbidity Evaluation-27 (ACE-27). Propensity score matching (PSM) was used to balance covariates between treatment groups. All-cause and PCa-specific mortality were primary endpoints. A subgroup analysis of patients with high-risk PCa (RP, n=89; IMRT, n=95) was conducted.

Results: Following PSM, matched patients (n=502 pairs) treated with either RP or IMRT were well-balanced with respect to covariates. With a median followup of 10.5 years (interquartile range [IQR] 9.9–11.0), the 11-year overall survival (OS) was 71.2% (95% confidence interval [CI] 66.9–75.8) for RP and 62.3% (95% CI 57.4–67.6) for IMRT. IMRT was associated with a 41% increased risk of all-cause mortality (hazard ratio [HR] 1.41, 95% CI 1.13– 1.76) but not PCa-specific mortality (HR 1.75, 95% CI 0.84–3.64), as compared to RP. In patients with high-risk PCa, IMRT, as compared to RP, was not associated with a statistically significant difference in all-cause (HR 1.53, 95% CI 0.97–2.42) or PCa-specific mortality (HR 1.92, 95% CI 0.69–5.36).

Conclusions: Despite a low mortality rate at 10 years and possible residual confounding, we found a significantly increased risk of all-cause mortality but no PCa-specific mortality associated with IMRT as compared to RP in this population-based study.

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Published

2022-02-28

How to Cite

Celtik, K., Wallis, C., Lo, M., Lim, K., Lipscomb, J. ., Fleming, S., Wu, X.-C., Anderson, R., Thompson, T., Farach, A., Hamilton, A., Miles, B., & Satkunasivam, R. (2022). Localized prostate cancer: An analysis of the Centers for Disease Control and Prevention Breast and Prostate Cancer Data Quality and Patterns of Care study (CDC PoC-BP). Canadian Urological Association Journal, 16(7), E391–8. https://doi.org/10.5489/cuaj.7580

Issue

Vol. 16 No. 7 (2022): CUAJ July

Section

Original Research

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