Advertisement

Outcomes of clinically localized prostate cancer patients managed with initial monitoring approach versus upfront local treatment: a North American population-based study

  • O. Abdel-RahmanEmail author
Research Article

Abstract

Objective

To assess the outcomes of active monitoring (active surveillance or watchful waiting) as an initial management approach compared to upfront definitive local treatments (prostatectomy or radiation therapy) in a cohort of clinically localized prostate cancer patients.

Methods

Patients with clinically localized prostate cancer registered within the Surveillance, Epidemiology and End Results (SEER) watchful waiting database from 2010–2015 were reviewed. Kaplan–Meier analysis was used to compare overall survival outcomes between patients treated with different initial therapeutic approaches. Multivariate Cox regression analysis (stratified by the risk group) was used to assess potential factors affecting prostate cancer-specific survival.

Results

Using Kaplan–Meier analysis, prostatectomy was associated with better overall survival compared to radiation therapy and active monitoring (P < 0.001). Multivariate Cox regression analysis was then employed to evaluate different factors affecting prostate cancer-specific survival. Among patients with low-risk disease, the following factors were predictive of better prostate cancer-specific survival: younger age (hazard ratio for patients ≥ 70 years versus patients 40–69 years: 2.081; 95% CI 1.277–3.390; P = 0.003), white race (hazard ratio for black race versus white race: 2.575; 95% CI 1.538–4.311; P < 0.001), non-Hispanic ethnicity (hazard ratio versus Hispanic ethnicity: 0.472; 95% CI 0.244–0.910; P = 0.025), and initial treatment with prostatectomy (hazard ratio for prostatectomy versus active monitoring: 0.551; 95% CI 0.371–0.818; P = 0.003).

Conclusions

Active monitoring seems to be at least as effective as upfront radiation therapy in the management of low-risk disease. Radical prostatectomy is associated with better overall and prostate cancer-specific survival compared to either radiation therapy or active monitoring.

Keywords

Prostate cancer Watchful waiting Active surveillance Surgery Radiation therapy Outcomes 

Notes

Acknowledgements

This study is based on the SEER watchful waiting database.

Funding

None.

Compliance with ethical standards

Conflict of Interest

All author declares that they have no conflict of interest.

Ethical approval

All analyses in the current study are aligned with established health ethics guidelines.

Informed consent

The current study is based on a publicly available dataset. Thus, Informed consent was not needed.

Supplementary material

12094_2019_2098_MOESM1_ESM.png (67 kb)
Supplementary figure-1: Kaplan-Meier curve for overall survival comparison according to treatment approach among patients with low-risk disease (in the post-matching cohort). (PNG 68 kb)
12094_2019_2098_MOESM2_ESM.docx (13 kb)
Supplementary file1 (DOCX 13 kb)

References

  1. 1.
    Bolla M, Gonzalez D, Warde P, Dubois JB, Mirimanoff R-O, Storme G, et al. Improved survival in patients with locally advanced prostate cancer treated with radiotherapy and Goserelin. N Engl J Med. 1997;337(5):295–300.CrossRefGoogle Scholar
  2. 2.
    Carroll PR, Parsons JK, Andriole G, Bahnson RR, Castle EP, Catalona WJ, et al. NCCN Guidelines insights: prostate cancer early detection, Version 2.2016. Journal of the National Comprehensive Cancer Network. 2016;14(5):509-19.Google Scholar
  3. 3.
    Bill-Axelson A, Holmberg L, Garmo H, Taari K, Busch C, Nordling S, et al. Radical prostatectomy or watchful waiting in prostate cancer—29-year follow-up. N Engl J Med. 2018;379(24):2319–29.CrossRefGoogle Scholar
  4. 4.
    Donovan JL, Hamdy FC, Lane JA, Mason M, Metcalfe C, Walsh E, et al. Patient-reported outcomes after monitoring, surgery, or radiotherapy for prostate cancer. N Engl J Med. 2016;375(15):1425–37.CrossRefGoogle Scholar
  5. 5.
    Dall’Era MA, Albertsen PC, Bangma C, Carroll PR, Carter HB, Cooperberg MR, et al. Active surveillance for prostate cancer: a systematic review of the literature. Eur Urol. 2012;62(6):976-83.Google Scholar
  6. 6.
    Coen JJ, Feldman AS, Smith MR, Zietman AL. Watchful waiting for localized prostate cancer in the PSA era: what have been the triggers for intervention? BJU Int. 2011;107(10):1582–6.CrossRefGoogle Scholar
  7. 7.
    Parker C, Gillessen S, Heidenreich A, Horwich A. Cancer of the prostate: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2015;26(Suppl 5):v69–77.CrossRefGoogle Scholar
  8. 8.
  9. 9.
    D'Amico AV, Whittington R, Malkowicz SB, Schultz D, Blank K, Broderick GA, et al. Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA. 1998;280(11):969–74.CrossRefGoogle Scholar
  10. 10.
    Nepple KG, Stephenson AJ, Kallogjeri D, Michalski J, Grubb RL 3rd, Strope SA, et al. Mortality after prostate cancer treatment with radical prostatectomy, external-beam radiation therapy, or brachytherapy in men without comorbidity. Eur Urol. 2013;64(3):372–8.CrossRefGoogle Scholar
  11. 11.
    Cooperberg MR, Vickers AJ, Broering JM, Carroll PR. Comparative risk-adjusted mortality outcomes after primary surgery, radiotherapy, or androgen-deprivation therapy for localized prostate cancer. Cancer. 2010;116(22):5226–344.CrossRefGoogle Scholar
  12. 12.
    Sun M, Sammon JD, Becker A, Roghmann F, Tian Z, Kim SP, et al. Radical prostatectomy vs radiotherapy vs observation among older patients with clinically localized prostate cancer: a comparative effectiveness evaluation. BJU International. 2014;113(2):200–8.CrossRefGoogle Scholar
  13. 13.
    Abdel-Rahman O. Outcomes of Prostatectomy versus Radiation Therapy in the Management of Clinically Localized Prostate Cancer Patients within the PLCO Trial. Clinical Genitourinary Cancer. 2019.Google Scholar
  14. 14.
    Hamdy FC, Donovan JL, Lane JA, Mason M, Metcalfe C, Holding P, et al. 10-year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer. N Engl J Med. 2016;375(15):1415–24.CrossRefGoogle Scholar

Copyright information

© Federación de Sociedades Españolas de Oncología (FESEO) 2019

Authors and Affiliations

  1. 1.Clinical Oncology Department, Faculty of MedicineAin Shams UniversityCairoEgypt
  2. 2.Department of OncologyUniversity of Calgary, Tom Baker Cancer CentreCalgaryCanada

Personalised recommendations