Urologic Oncology: Seminars and Original Investigations
Original articleSignificant increase in prostatectomy and decrease in radiation for clinical T3 prostate cancer from 1998 to 2012
Introduction
Radiation and long-term androgen deprivation therapy (ADT) has been a standard of care for clinical T3 prostate cancer (PCa) since the 1997 publication of the EORTC 22863 trial by Bolla et al. [1] demonstrating that combination radiation therapy (RT) with 3 years of ADT improved overall survival compared with RT alone. Beginning with the 1999 National Comprehensive Cancer Network (NCCN) guidelines, radical prostatectomy (RP) was listed as an acceptable treatment for small, low-grade, clinical T3 PCa [2]. Since then, publication of the Swedish prostatectomy randomized trial showing a survival benefit for men with clinically localized PCa may have increased enthusiasm for RP in even locally advanced disease [3]. Several retrospective studies have also reported good biochemical recurrence-free survival and cancer-specific survival rates following RP for patients with T3b disease [4], [5], [6]. In this study, we aim to investigate how the proportion of patients receiving RP vs. RT changed from 1998 to 2012 for clinical T3 PCa, as well as identify what demographic and clinical factors influence receipt of RP and RT.
Section snippets
Patient selection
The Surveillance, Epidemiology, and End Results (SEER) database is a population-based, cancer registry that collects demographic characteristics and cancer diagnostic, treatment, and survival data [7]. SEER covers 18 U.S. regions, including approximately 28% of the US population. Using SEER⁎Stat 8.1.5, we extracted data on 12,815 men diagnosed with clinical T3, histologically confirmed prostatic adenocarcinoma between 1998 and 2012. Patients with clinical T1–T2 disease who were upstaged to
Baseline patient characteristics
Table 1 lists baseline demographic and clinical characteristics for our cohort of 11,341 men with clinical T3/N0/M0 PCa. The median age overall was 67 years (range: 38–99), and 62 for RP, 68 for RT, and 75 for no curative therapy (P<0.001). Most patients were white (72.5%) and married (67.6%). For all patients, the median county-level household income was $46,680 and the median county-level percentage of adults without a high school diploma was 17.4%. Clinically, 33.1% of patients had clinical
Discussion
In this study of 11,604 men with cT3N0M0 PCa from 1998 to 2012, we found that rates of prostatectomy (RP) significantly increased from 12.5% to 44.4% over the study period, whereas the rates of RT greatly decreased from 55.8% to 38.4%. In 2012, the overall rate of RP was significantly higher than RT for clinical T3 patients (cT3, 44.4% vs. 38.4%, P = 0.023). Rates of RP have surpassed RT since 2008 in cT3a disease and were statistically similar to RT in 2012 for cT3b. This strong trend towards
Conclusion
Since 1998, there has been a significant increase in the use of RP for clinical T3 PCa and a significant decrease in the use of radiation such that in 2012, the use of prostatectomy exceeded the use of radiation. There is a need for further prospective work to identify what subgroups of locally advanced patients with PCa may be best served by prostatectomy vs. radiation.
Acknowledgments
This work is supported financially by Fitz׳s Cancer Warriors, David and Cynthia Chapin, the Prostate Cancer Foundation, Hugh Simons in honor of Frank and Anne Simons, Scott Forbes and Gina Ventre, The Campbell Family in Honor of Joan Campbell, and a grant from an anonymous family foundation. All listed authors were involved in the design, data analysis, and manuscript preparation, and all authors approved the final version of this paper. Paul L. Nguyen has consulted for Medivation and GenomeDX.
References (37)
- et al.
A contemporary analysis of outcomes of adenocarcinoma of the prostate with seminal vesicle invasion (pT3b) after radical prostatectomy
J Urol
(2011) - et al.
Biochemical and pathological predictors of the recurrence of prostatic adenocarcinoma with seminal vesicle invasion
J Urol
(2003) US National Cancer Institute investigates PSA coding errors
Lancet Oncol
(2015)- et al.
Radical prostatectomy as primary treatment modality for locally advanced prostate cancer: a prospective analysis
Urology
(2006) - et al.
What are the outcomes of radical prostatectomy for high-risk prostate cancer?
Urology
(2010) - et al.
Secondary therapy, metastatic progression, and cancer-specific mortality in men with clinically high-risk prostate cancer treated with radical prostatectomy
Eur Urol
(2008) - et al.
Long-term survival after radical prostatectomy for men with high Gleason sum in pathologic specimen
Urology
(2010) - et al.
An analysis of radical prostatectomy in advanced stage and high-grade prostate cancer
Eur Urol
(2008) - et al.
Postoperative radiotherapy after radical prostatectomy: a randomised controlled trial (EORTC trial 22911)
Lancet
(2005) - et al.
Endocrine treatment, with or without radiotherapy, in locally advanced prostate cancer (SPCG-7/SFUO-3): an open randomised phase III trial
Lancet
(2009)
Combined androgen deprivation therapy and radiation therapy for locally advanced prostate cancer: a randomised, phase 3 trial
Lancet
Local control following permanent prostate brachytherapy: effect of high biologically effective dose on biopsy results and oncologic outcomes
Int J Radiat Oncol Biol Phys
Economics of robotic surgery: does it make sense and for whom?
Urol Clin North Am
Undertreatment of men in their seventies with high-risk nonmetastatic prostate cancer
Eur Urol
Racial/ethnic disparities in the treatment of localized/regional prostate cancer
J Urol
Improved survival in patients with locally advanced prostate cancer treated with radiotherapy and goserelin
N Engl J Med
Update: NCCN Practice Guidelines for the treatment of prostate cancer
Oncology
Radical prostatectomy versus watchful waiting in early prostate cancer
N Engl J Med
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Authors contributed equally to this manuscript.