Early Mortality of Prostatectomy vs. Radiotherapy as a Primary Treatment for Prostate Cancer: A Population-Based Study From the United States and East Germany.

To assess the extent of early mortality and its temporal course after prostatectomy and radiotherapy in the general population. Data from the Surveillance, Epidemiology, and End Results (SEER) database and East German epidemiologic cancer registries were used for the years 2005-2013. Metastasized cases were excluded. Analyzing overall mortality, year-specific Cox regression models were used after adjusting for age (including age squared), risk stage, and grading. To estimate temporal hazards, we computed year-specific conditional hazards for surgery and radiotherapy after propensity-score matching and applied piecewise proportional hazard models. In German and US populations, we observed higher initial 3-month mortality odds for prostatectomy (USA: 9.4, 95% CI: 7.8-11.2; Germany: 9.1, 95% CI: 5.1-16.2) approaching the null effect value not before 24-months (estimated annual mean 36-months in US data) after diagnosis. During the observational period, we observed a constant hazard ratio for the 24-month mortality in the US population (2005: 1.7, 95% CI: 1.5-1.9; 2013: 1.9, 95% CI: 1.6-2.2) comparing surgery and radiotherapy. The same was true in the German cohort (2005: 1.4, 95% CI: 0.9-2.1; 2013: 3.3, 95% CI: 2.2-5.1). Considering low-risk cases, the adverse surgery effect appeared stronger. There is strong evidence from two independent populations of a considerably higher early to midterm mortality after prostatectomy compared to radiotherapy extending the time of early mortality considered by previous studies up to 36-months.