Relative 10-year survival after surgery, EBRT, or brachytherapy in ...

A new study on relative rates of survival at 10 years, just published on line, is probably going to get differing reactions from patients and from physicians depending on their individual points of view.

Kibel et al. have reported data from an analysis of the 10-year, overall survival and the prostate cancer-specific mortality rates of more than 10,000 men treated at tweo major institutions with any one of three, standard first-line therapies for clinically localized prostate cancer between 1995 and 2005.

The analysis is based on data from?10,429 consecutive?patients treated at either Barnes-Jewish Hospital (associated with Washington University in St. Louis, Missouri) or at the Cleveland Clinic (in Cleveland, Ohio). The actual breakdown of the number of patients treated was:

• 6,485 received a radical prostatectomy of some type
• 2,264 were treated with some form of external beam radiation therapy (EBRT)
• 1,680 were treated with?permanent seed implant brachytherapy.

The research team also collected information on the race, age, and comorbidities of all the patients;?on and disease-specific parameters (e.g., PSA, biopsy Gleason score, and clinical stage); and on relevant details of the patients? treatments. It is worth noting up front that this study was carried out under the oversight of Drs. Michael Kattan and Andrew Stephenson of the Cleveland Clinic, who probably have more experience of this type of analysis than almost anyone else conducting research of this type today.

So, without trying to get into a lot of the details, here are the fundamental findings of their research:

• Adjusted 10-year overall survival of the patients by type of treatment were
  • 88.9 percent for those who had radical prostatectomy
  • 82.6 percent for those?who had EBRT
  • 81.7 percent for those who had brachytherapy
• Adjusted 10-year prostate cancer specific mortality rates for the patients by treatment type were
  • 1.8 percent for those who had radical prostatectomy
  • 2.9 percent for those who had EBRT
  • 2.3 percent for those who had brachytherapy, respectively.
• Based on propensity score analysis (the type of statistical analysis used in this study)
  • EBRT was associated with decreased overall survival (hazard ratio [HR] =?1.6; p < 0.001) compared to radical prostatectomy.
  • EBRT was associated with?increased prostate cancer-specific mortality (HR = 1.5; p = 0.041) compared to radical prostatectomy.
  • Brachytherapy was associated with decreased overall survival (HR = 1.7; p <0.001) compared to radical prostatectomy.
  • Brachytherapy was?not associated with increased prostate cancer-specific mortality (HR = 1.3; p = 0.5) compared to radical prostatectomy.

However, the authors go to considerable lengths in the full text of their paper to point out that ? even though?radical surgery?was associated with improved overall survival and prostate cancer-specific mortality compared to EBRT and brachytherapy in this particular study ??

?? the absolute improvement in overall and [prostate cancer-specific mortality] among groups at 10 years was modest.

They further note that,

These survival differences may arise from an imbalance of patient or disease related confounders despite our efforts to adjust for them, from improved cancer control when?[radical prostatectomy]?is performed as initial therapy, and/or from differences in treatment related mortality.

It seems likely to The ?New? Prostate Cancer InfoLink that the ?best? way to look at this study is to see it as showing that the overall 10-year survival rates from these three widely used?types of first-line therapy (when carried out at apporopriately expert facilities) is high, at > 80 percent, and that the 10-year prostate cancer-s[pecific mortality rates are low, at < 3 percent. This perspective is put into context by the first paragraph of the "Discussion" section of this paper by Kibel et al.:

A man with clinically localized?[prostate cancer]?is faced with a challenging process of selecting the optimal treatment. He must choose between radical therapy and surveillance for a cancer that may pose an uncertain threat to his longevity or quality of life.If he chooses treatment, none has been proven superior in terms of quantity or quality of life. In the absence of data from randomized trials, one must rely on observational studies, although these may be biased. In this study, to our knowledge the largest comparative analysis of contemporary patients treated according to current treatment standards,?[radical prostatectomy]?was associated with improved overall survival compared to EBRT and brachytherapy after adjusting for major confounders, and improved?[prostate cancer-specific mortality]?compared to EBRT. However, the differences in adjusted survival among treatment modalities at 10 years were small, particularly for [prostate cancer-specific mortality].

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Filed under: Diagnosis, Living with Prostate Cancer, Management, Treatment Tagged: | comparative, mortality, outcome, survival

Source: http://prostatecancerinfolink.net/2012/02/20/relative-10-year-survival-after-surgery-ebrt-or-brachytherapy-in-the-psa-era/

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