Sophie Knipper1, Angela Pecoraro2, Carlotta Palumbo3, Giuseppe Rosiello4, Stefano Luzzago5, Zhe Tian6, Alberto Briganti7, Fred Saad6, Derya Tilki8, Markus Graefen9, Pierre I Karakiewicz6. 1. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada. Electronic address: a.knipper@uke.de. 2. Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada; Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy. 3. Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada; Urology Unit, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy. 4. Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada; Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy. 5. Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada; European Institute of Oncology, Milan, Italy. 6. Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada. 7. Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy. 8. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany. 9. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Abstract
BACKGROUND: We examined the changes over time in other-cause mortality (OCM) rates in patients with clinically localized prostate cancer (PCa) as an indicator of patient selection. PATIENTS AND METHODS: Within the Surveillance, Epidemiology, and End Results database (1987-2011), we identified patients with PCa treated with either radical prostatectomy (RP) (n = 230,969; 62.8%) or external beam radiation therapy (EBRT) (n = 136,915; 37.2%). Temporal trends and multivariable Cox regression analyses assessed OCM at 5 years using stratification according to year of diagnosis (1987-1991 vs. 1992-1996 vs. 1997-2001 vs. 2002-2006 vs. 2007-2011), age group, and ethnicity. RESULTS: In patients who had undergone RP, the OCM rates at 5 years of follow-up decreased over time from 7.9% to 2.4% (slope, -0.25%/year) versus from 15.2% to 9.9% after EBRT (slope, -0.29%/year). The greatest decrease in 5-year OCM rates over time was recorded in patients ≥ 75 years (16.0%-12.0%; slope, -0.25%/year), followed by younger age categories (70-74 years, -0.21%/year; 65-69 years, -0.17%/year; 60-64 years, -0.10%/year; < 60 years, -0.07%/year), as well as in African-American men (11.0%-5.1%; slope, -0.32%/year), followed by Caucasian (7.6%-3.4%; slope, -0.21%/year) and Hispanic men (7.0%-3.1%; slope, -0.20%/year; all P < .001), as corroborated in multivariable Cox regression models. CONCLUSIONS: OCM rates were highest in oldest individuals and in African-American men. In both groups, an important 5-year OCM reduction over the 25-year study span was recorded. Nonetheless, these 2 patient groups may still represent the ideal target for better patient selection based on OCM considerations, because their most recent OCM rates exceeded those of, respectively, younger and Caucasian patients.
BACKGROUND: We examined the changes over time in other-cause mortality (OCM) rates in patients with clinically localized prostate cancer (PCa) as an indicator of patient selection. PATIENTS AND METHODS: Within the Surveillance, Epidemiology, and End Results database (1987-2011), we identified patients with PCa treated with either radical prostatectomy (RP) (n = 230,969; 62.8%) or external beam radiation therapy (EBRT) (n = 136,915; 37.2%). Temporal trends and multivariable Cox regression analyses assessed OCM at 5 years using stratification according to year of diagnosis (1987-1991 vs. 1992-1996 vs. 1997-2001 vs. 2002-2006 vs. 2007-2011), age group, and ethnicity. RESULTS: In patients who had undergone RP, the OCM rates at 5 years of follow-up decreased over time from 7.9% to 2.4% (slope, -0.25%/year) versus from 15.2% to 9.9% after EBRT (slope, -0.29%/year). The greatest decrease in 5-year OCM rates over time was recorded in patients ≥ 75 years (16.0%-12.0%; slope, -0.25%/year), followed by younger age categories (70-74 years, -0.21%/year; 65-69 years, -0.17%/year; 60-64 years, -0.10%/year; < 60 years, -0.07%/year), as well as in African-American men (11.0%-5.1%; slope, -0.32%/year), followed by Caucasian (7.6%-3.4%; slope, -0.21%/year) and Hispanic men (7.0%-3.1%; slope, -0.20%/year; all P < .001), as corroborated in multivariable Cox regression models. CONCLUSIONS: OCM rates were highest in oldest individuals and in African-American men. In both groups, an important 5-year OCM reduction over the 25-year study span was recorded. Nonetheless, these 2 patient groups may still represent the ideal target for better patient selection based on OCM considerations, because their most recent OCM rates exceeded those of, respectively, younger and Caucasian patients.
Authors: Benedikt Hoeh; Jan L Hohenhorst; Rocco Flammia; Benedikt Horlemann; Gabriele Sorce; Francesco Chierigo; Zhe Tian; Fred Saad; Markus Graefen; Michele Gallucci; Alberto Briganti; Carlo Terrone; Shahrokh F Shariat; Luis A Kluth; Andreas Becker; Felix K H Chun; Pierre I Karakiewicz Journal: Int Urol Nephrol Date: 2021-11-16 Impact factor: 2.370
Authors: Francesco Chierigo; Marco Borghesi; Christoph Würnschimmel; Rocco S Flammia; Benedikt Horlemann; Gabriele Sorce; Benedikt Hoeh; Zhe Tian; Fred Saad; Markus Graefen; Michele Gallucci; Alberto Briganti; Francesco Montorsi; Felix K H Chun; Shahrokh F Shariat; Guglielmo Mantica; Nazareno Suardi; Carlo Terrone; Pierre I Karakiewicz Journal: Prostate Date: 2022-02-28 Impact factor: 4.012