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Comparative effectiveness of surgery versus external beam radiation with/without brachytherapy in high‐risk localized prostate cancer
- Source :
- Cancer Medicine, Vol 9, Iss 1, Pp 27-34 (2020), Cancer Medicine
- Publication Year :
- 2019
- Publisher :
- Wiley, 2019.
-
Abstract
- Background It remains controversial if radical prostatectomy or definitive radiation therapy produces equivalent outcomes in high‐risk localized prostate cancer. Methods We queried The Surveillance, Epidemiology, and End Results (SEER) database for those who received upfront surgery or who were recommended for surgery but instead received radiation. Inverse probability of treatment weighing was used to adjust for covariate imbalance and the weighted Cox proportional hazards model was used to estimate the effects of treatment groups on survival. A meta‐analysis was performed to pool estimates from published studies. Results Among eligible 62 533 patients, 59 540 had upfront surgery and 2993 patients had upfront radiotherapy. EBRT + BT was associated with a superior cancer‐specific survival (CSS) compared with surgery or EBRT alone (HR, 0.55, 95% CI, 0.3‐1.0; HR, 0.49, 95% CI, 0.24‐0.98, respectively), whereas EBRT was associated with an inferior overall survival (OS) compared with surgery (HR, 1.46, 95% CI, 1.16‐1.8). Radiotherapy (EBRT ± BT) was inferior to surgery by OS (HR, 1.63, 95% CI, 1.13‐2.34) in patients ≤ 65 years, and was superior to surgery by CSS in patients > 65 years (HR, 0.69, 95% CI, 0.49‐0.97). The meta‐analysis showed consistent results. Conclusion EBRT + BT was associated with a significantly better prostate CSS compared with surgery or EBRT. EBRT alone was inferior to surgery by OS.<br />In high‐risk localized prostate cancer, radiotherapy with brachytherapy boost was associated with a longer survival outcome, compared with surgery or radiotherapy without brachytherapy boost.
- Subjects :
- Male
0301 basic medicine
Cancer Research
medicine.medical_treatment
Brachytherapy
External beam radiation
Kaplan-Meier Estimate
radiation therapy
surgery
Prostate cancer
0302 clinical medicine
Risk Factors
Prostate
Epidemiology
Original Research
Prostatectomy
Age Factors
Middle Aged
prostate cancer
lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Combined Modality Therapy
medicine.anatomical_structure
Oncology
030220 oncology & carcinogenesis
Kallikreins
medicine.medical_specialty
survival
lcsh:RC254-282
03 medical and health sciences
medicine
Humans
Radiology, Nuclear Medicine and imaging
Propensity Score
Aged
Proportional Hazards Models
Retrospective Studies
Proportional hazards model
business.industry
Clinical Cancer Research
Prostatic Neoplasms
Prostate-Specific Antigen
medicine.disease
United States
Surgery
Radiation therapy
030104 developmental biology
business
Follow-Up Studies
SEER Program
Subjects
Details
- ISSN :
- 20457634
- Volume :
- 9
- Database :
- OpenAIRE
- Journal :
- Cancer Medicine
- Accession number :
- edsair.doi.dedup.....fba8c5a41c05d12a7491dd770b188301