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Kim AH , Konety B , Chen Z , Schumacher F , Kutikov A , Smaldone M , Abouassaly R , Khanna A , Kim SP
Comparative Effectiveness of Local and Systemic Therapy for T4 Prostate Cancer
Urology. 2018 Oct;120 :173-179
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OBJECTIVE: To evaluate the comparative effectiveness of local versus systemic therapy among patients diagnosed with non-metastatic clinical T4 prostate cancer. METHODS: Using the National Cancer Database (NCDB) men with clinical T4N0-1M0 prostate cancer from 2004 to 2013 were identified. Local therapy was defined as radiation (RT with ADT), surgery (radical prostatectomy with ADT), or combined radiation plus surgery (radical prostatectomy plus RT with ADT). Systemic therapy was defined as ADT or chemotherapy alone. The primary outcome of overall survival was estimated using the Kaplan Meier method. Factors associated with overall survival were determined by Cox proportional hazards models. RESULTS: A total of 1,914 patients were included in our analysis, 1,559 received local therapy and 355 received systemic therapy. Median 5-year survival for local versus systemic therapy was 41.5 and 28.2 months, respectively. On multivariable analysis, local therapy was associated with increased overall survival compared to systemic therapy (HR=0.52; 95%CI, 0.44-0.62, p<0.001). Comparing local therapy treatment modalities, both radiation (HR=0.44; 95%CI, 0.36-0.53, p<0.001) and surgery (HR=0.67; 95%CI, 0.55-0.82, p<0.001) were associated with increased overall survival compared to systemic therapy. Among those receiving local therapy, more patients were treated with radiation (n=709/1559 or 45.5%) compared to surgery (n=560/1559 or 35.9%) or combined radiation plus surgery (n=290/1559 or 18.6%) with 5-year overall survival by treatment type being 61%, 51.4% and 62.2%, respectively. CONCLUSIONS: Local therapy for clinical T4 prostate cancer is associated with improved overall survival. Due to the retrospective, non-randomized nature of the study design, a clinical trial is needed to better define the efficacy of local therapy in this high-risk patient population.
1527-9995 Kim, Albert H Konety, Badrinath Chen, Zhengyi Schumacher, Fredrick Kutikov, Alexander Smaldone, Marc Abouassaly, Robert Khanna, Abhinav Kim, Simon P Journal Article United States Urology. 2018 Jul 7. pii: S0090-4295(18)30630-7. doi: 10.1016/j.urology.2018.06.038.