Radical prostatectomy tied to higher survival than radiotherapy in prostate cancer

Treatment with radiotherapy appears to result in more all-cause or prostate cancer-specific mortality (PCSM) compared with radical prostatectomy (RP), suggests a study.

A team of investigators compared the outcomes among patients treated with either radiation or prostatectomy for nonmetastatic prostate cancer using a provincial population-based linked data set from an equal-access, universal healthcare system.

A retrospective cohort study was conducted on patients who were diagnosed with prostate cancer between 2004 and 2016 in Manitoba, Canada, and were then treated with either RP or RT. The investigators used Cox proportional hazard models with inverse probability of treatment weighting to compare the rates of all-cause mortality and PCSM between the two treatment groups.

A total of 2,540 patients underwent RP and 1,895 received RT for prostate cancer during the study period. Unadjusted 5-year overall survival was higher for RP than RT (95.52 percent vs 84.55 percent; p<0.0001).

Inverse probability of treatment weighting-adjusted Cox regression analysis revealed higher rates of all-cause mortality (hazard ratio [HR], 1.93, 95 percent confidence interval [CI], 1.65‒2.26; p<0.0001) and PCSM (HR, 3.98, 95 percent CI, 2.89‒5.49; p<0.0001) among patients in the RT group compared to those in the RP group.

“RT was associated with higher all-cause mortality and PCSM rates compared with RP,” the investigators said. “These findings highlight the importance of comparative effectiveness research to identify treatment disparities and warrant further investigation.”