Sussman Rachael, Carvalho Filipe L F, Harbin Andrew, Zheng Choayi, Lynch John H, Stamatakis Lambros, Hwang Jonathan, Williams Stephen B, Hu Jim C, Kowalczyk Keith J
Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA.
Can J Urol. 2018 Oct;25(5):9516-9524.
The utility of radical prostatectomy (RP) for locally-advanced prostate cancer remains unknown. Retrospective data has shown equivalent oncologic outcomes compared to radiation therapy (RT). RP may provide local tumor control and prevent secondary interventions from local invasion, and may decrease costs.
Using SEER-Medicare data from 1995-2011 we identified men with locally-advanced prostate cancer undergoing RP or RT. Rates of post-treatment diagnoses and interventions were identified using ICD-9 and CPT codes. Skeletal related events (SRE), androgen deprivation therapy (ADT) utilization, all-cause mortality, prostate cancer-specific mortality, and costs were compared.
A total of 8367 men with locally-advanced prostate cancer were identified (6200 RP, 2167 RT). RT was associated with increased urinary obstruction, hematuria, infection, and cystoscopic intervention while RP was associated with increased urethral stricture intervention and erectile dysfunction. Compared to RT, RP was associated with decreased all-cause mortality (3.1 versus 5.2 deaths/100-person-years, p < 0.001), prostate cancer-specific mortality (0.8 versus 2.0 deaths/100-person-years, p < 0.001), SREs (2.0 versus 3.4 events/100 person-years, p < 0.001), and ADT utilization overall (7.4 versus 33.8 doses/100-person-years, p < 0.001) and > 3 years after treatment (3.6 versus 4.6 doses/100-person-years, p < 0.001). Overall and cancer specific costs were significantly lower for RP versus RT.
RT for locally-advanced prostate cancer has a higher incidence of mortality, secondary diagnoses and interventions, SRE, and ADT utilization compared to RP. This may lead to increased costs and have implications for quality of life. Our findings support the utility of RP in appropriately selected men with locally-advanced prostate cancer given the possible decreased morbidity and survival benefit.
根治性前列腺切除术（RP）对于局部晚期前列腺癌的效用尚不清楚。回顾性数据显示，与放射治疗（RT）相比，其肿瘤学结局相当。RP可能提供局部肿瘤控制并防止因局部侵犯而进行二次干预，且可能降低成本。
利用1995 - 2011年的监测、流行病学与最终结果（SEER）医保数据，我们确定了接受RP或RT的局部晚期前列腺癌男性患者。使用国际疾病分类第九版（ICD - 9）和现行程序编码（CPT）来确定治疗后诊断和干预的发生率。比较了骨相关事件（SRE）、雄激素剥夺治疗（ADT）的使用情况、全因死亡率、前列腺癌特异性死亡率及成本。
共确定了8367例局部晚期前列腺癌男性患者（6200例行RP，2167例行RT）。RT与尿路梗阻、血尿、感染及膀胱镜干预增加相关，而RP与尿道狭窄干预及勃起功能障碍增加相关。与RT相比，RP与全因死亡率降低相关（3.1例死亡/100人年对5.2例死亡/100人年，p < 0.001）、前列腺癌特异性死亡率降低相关（0.8例死亡/100人年对2.0例死亡/100人年，p < 0.001）、SREs减少相关（2.0次事件/100人年对3.4次事件/100人年，p < 0.001），总体ADT使用减少（7.4剂/100人年对33.8剂/每人年，p < 0.001）以及治疗后> 3年时ADT使用减少（3.6剂/100人年对4.6剂/100人年，p < 0.001）。RP的总体成本和癌症特定成本显著低于RT。
与RP相比，局部晚期前列腺癌的RT在死亡率、二次诊断和干预、SRE及ADT使用方面发生率更高。这可能导致成本增加并对生活质量产生影响。鉴于可能降低的发病率和生存获益，我们的研究结果支持在适当选择的局部晚期前列腺癌男性患者中使用RP。
