Transcript Surgery v Radiation in Prostate Cancer

Surgery v Radiation in Prostate
Cancer
Prasanna Sooriakumaran MD PhD
&
Peter Wiklund MD PhD
Background
• Comparative series so far suggest surgery may
have improved oncologic outcomes over
radiation
• Subject to non-comprehensive data and
confounding by indication
• Lack of important covariates inc. comorbidity
• ProtecT results expected in 2016
Methods
• 34515 men, >98% capture of all men with
prostate cancer in Sweden 1998 onwards
• Comprehensive dataset of all relevant
covariates inc. patient and tumor factors due
to linking National Prostate Cancer Register of
Sweden to 8 other national registries
• Comprehensive and robust statistical
modeling to adjust for baseline differences
between surgery and radiation
Methods
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Fine & Gray competing risks analysis
Multivariable regression
Propensity score modeling
Inverse probability of treatment weights
Propensity score matching
Sensitivity analysis looking specifically for residual
confounding
• Analysis stratified by year of treatment to look for
differential effects based on increasing radiation
dose with time
Fig 1 Cumulative incidence function estimates of cancer specific and other cause mortality
survival curves (n=34 515), stratified according to treatment type.
Sooriakumaran P et al. BMJ 2014;348:bmj.g1502
©2014 by British Medical Journal Publishing Group
Fig 2 Forest plot depicting propensity score adjusted subdistribution hazard ratios (sHR) for
radiotherapy versus radical prostatectomy for cancer specific mortality stratified by risk group,
and substratified by age and Charlson comorbidity index score.
Sooriakumaran P et al. BMJ 2014;348:bmj.g1502
©2014 by British Medical Journal Publishing Group
Conclusions
• Surgery reduced risk of prostate cancer death
in all localized prostate cancer risk groups
• Greatest benefit for surgery over radiation
appeared in intermediate and high risk groups
in men with long life expectancies
• Men with metastatic or micrometastatic
disease did not benefit from one form of
radical therapy over the other