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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
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology. Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
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2017 (English)In: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 72, no 1, 125-134 p.Article 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 50–200 ng/ml, any N, and M0). Men with locally advanced PCa (local clinical stage T3 and PSA level <50 ng/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
Elsevier, 2017. Vol. 72, no 1, 125-134 p.
Keyword [en]
Prostate cancer, Very high-risk, Radical, Treatment, Semiecologic, Nationwide, Population-based, PCBaSe
National Category
Urology and Nephrology
Identifiers
URN: urn:nbn:se:umu:diva-137374DOI: 10.1016/j.eururo.2016.07.023ISI: 000403205900026OAI: oai:DiVA.org:umu-137374DiVA: diva2:1120664
Available from: 2017-07-06 Created: 2017-07-06 Last updated: 2017-07-06Bibliographically approved

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Stattin, PärJonsson, Håkan
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