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Association of Radical Local Treatment with Mortality in Men with Very High-risk Prostate Cancer: A Semiecologic, Nationwide, Population-based Study
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2016 (English)In: Eur UrolArticle in journal (Refereed) Published
Abstract [en]

BACKGROUND: Current guidelines recommend androgen deprivation therapy only for men with very high-risk prostate cancer (PCa), but there is little evidence to support this stance. OBJECTIVE: To investigate the association between radical local treatment and mortality in men with very high-risk PCa. DESIGN, SETTING, AND PARTICIPANTS: Semiecologic study of men aged <80 yr within the Prostate Cancer data Base Sweden, diagnosed in 1998-2012 with very high-risk PCa (local clinical stage T4 and/or prostate-specific antigen [PSA] level 50-200ng/ml, any N, and M0). Men with locally advanced PCa (local clinical stage T3 and PSA level <50ng/ml, any N, and M0) were used as positive controls. INTERVENTION: Proportion of men who received prostatectomy or full-dose radiotherapy in 640 experimental units defined by county, diagnostic period, and age at diagnosis. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: PCa and all-cause mortality rate ratios (MRRs). RESULTS AND LIMITATIONS: Both PCa and all-cause mortality were half as high in units in the highest tertile of exposure to radical local treatment compared with units in the lowest tertile (PCa MRR: 0.51; 95% confidence interval [CI], 0.28-0.95; and all-cause MRR: 0.56; 95% CI, 0.33-0.92). The results observed for locally advanced PCa for highest versus lowest tertile of exposure were in agreement with results from randomized trials (PCa MRR: 0.75; 95% CI, 0.60-0.94; and all-cause MRR: 0.85; 95% CI, 0.72-1.00). Although the semiecologic design minimized selection bias on an individual level, the effect of high therapeutic activity could not be separated from that of high diagnostic activity. CONCLUSIONS: The substantially lower mortality in units with the highest exposure to radical local treatment suggests that radical treatment decreases mortality even in men with very high-risk PCa for whom such treatment has been considered ineffective. PATIENT SUMMARY: Men with very high-risk prostate cancer diagnosed and treated in units with the highest exposure to surgery or radiotherapy had a substantially lower mortality.

Place, publisher, year, edition, pages
2016.
National Category
Urology and Nephrology
Identifiers
URN: urn:nbn:se:umu:diva-134588ISBN: 1873-7560 (Electronic) 0302-2838 (Linking) OAI: oai:DiVA.org:umu-134588DiVA: diva2:1094169
Note

Stattin, Par Sandin, Fredrik Thomsen, Frederik Birkebaek Garmo, Hans Robinson, David Lissbrant, Ingela Franck Jonsson, Hakan Bratt, Ola ENG 2016/08/03 06:00 Eur Urol. 2016 Jul 29. pii: S0302-2838(16)30428-6. doi: 10.1016/j.eururo.2016.07.023.

Available from: 2017-05-09 Created: 2017-05-09 Last updated: 2017-05-09

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http://www.ncbi.nlm.nih.gov/pubmed/27481175http://ac.els-cdn.com/S0302283816304286/1-s2.0-S0302283816304286-main.pdf?_tid=7cf12856-606b-11e6-a431-00000aab0f02&acdnat=1470992725_9ea9be4e754a500fd395db4e3d21176fhttp://ac.els-cdn.com/S0302283816304286/1-s2.0-S0302283816304286-main.pdf?_tid=0d011600-349b-11e7-8f88-00000aab0f01&acdnat=1494322800_358074f40fe3670776a9e637c256dda6
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CiteExportLink to record
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