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Basic Research

Primary radiotherapy vs conservative management for localized prostate cancer—a population-based study

Prostate Cancer and Prostatic Diseases volume 18, pages 317–324 (2015)Cite this article

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Abstract

Background:

Radiotherapy is the most common curative cancer therapy used for elderly patients with localized prostate cancer. However, the effectiveness of this approach has not been established. The purpose of this study is to evaluate the long-term outcomes of primary radiotherapy compared with conservative management in order to facilitate treatment decisions.

Method:

This population-based study consisted of 57 749 patients with T1–T2 prostate cancers diagnosed during 1992–2007. We utilized an instrumental variable (IV) analytical approach with competing risk models to evaluate the outcomes of primary radiotherapy vs conservative management. The IV was comprised of combined health service areas with high- and low-use areas corresponding to the top and bottom tertile in radiotherapy usage rates.

Results:

In patients with low-/intermediate-risk prostate cancer, 10-year prostate cancer-specific and overall survival was similar in high- and low-radiotherapy use areas (96.1 vs 95.4% and 56.6 vs 56.3%, respectively). In patients with high-risk disease, however, areas with high-radiotherapy use had a higher 10-year cancer-specific survival (90.2 vs 88.1%, difference 2.1%; 95% CI 0.3–4.0%) and 10-year overall survival (53.3 vs 50.2%, difference 3.1%; 95% CI 1.3–6.3%). Results were similar irrespective of the type of radiotherapy used. To assess the robustness of our choice of IV, we repeated the IV analytical approach using different IVs (using the median utilization rate as the cutoff) and found the results to be similar.

Conclusions:

Among men >65 years of age, the benefit of primary radiotherapy for localized disease is largely confined to patients with high-risk prostate cancer (Gleason scores 7–10).

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Acknowledgements

We acknowledge the efforts of the Applied Research Branch, Division of Cancer Prevention and Population Science, National Cancer Institute, the Office of Information Services and the Office of Strategic Planning, Center for Medicare and Medicaid Services, Information Management Services and the Surveillance, Epidemiology and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database. This study was approved by the NCI, CMS and Rutgers RBHS IRB. We thank Carolina Lozada and Edith Prescod for their outstanding technical and administrative assistance. The project described was supported by Award number RC1CA145722 from the National Cancer Institute (NCI) and Rutgers Cancer Institute of New Jersey CCSG core grant NCI CA-72720.

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Author notes

  1. S Shen

    Present address: 6Current address: Eli Lily, Bridgewater, NJ, USA,

Authors and Affiliations

  1. Department of Medicine, Rutgers, Robert Wood Johnson Medical School, Piscataway, NJ, USA

    G L Lu-Yao, R S DiPaola & S-L Yao

  2. Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA

    G L Lu-Yao, S Kim, D F Moore, W Shih, Y Lin, R S DiPaola, S Shen & S-L Yao

  3. Department of Radiation Oncology, Rutgers, Robert Wood Johnson Medical School, New Brunswick, NJ, USA

    S Kim

  4. Department of Biostatistics, Rutgers, School of Public Health, Piscataway, NJ, USA

    D F Moore, W Shih & Y Lin

  5. Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA

    A Zietman

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Corresponding author

Correspondence to G L Lu-Yao.

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Competing interests

During the past 5 years, the following authors have received financial support and maintained affiliations as follows: GLL-Y has been a consultant for Merck Research Laboratories. In addition, S-LY has been employed by Schering-Plough, Merck and Sun Pharmaceuticals LLC in the area of clinical research. None of these entities contributed funding, or played any role whatsoever in the design, interpretation or drafting of our study or manuscript.

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This study utilizes the Linked SEER-Medicare Database. NCI is not involved in the design or conduct of this study. The content is solely the responsibility of the authors and does not necessarily represent the official view of the National Cancer Institute or the National Institute of Health.

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Lu-Yao, G., Kim, S., Moore, D. et al. Primary radiotherapy vs conservative management for localized prostate cancer—a population-based study. Prostate Cancer Prostatic Dis 18, 317–324 (2015). https://doi.org/10.1038/pcan.2015.30

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