Andri Wilberg Orrason1, Marcus Westerberg2, Hans Garmo1, Ingela Franck Lissbrant3, David Robinson4, Pär Stattin1. 1. Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden. 2. Department of Mathematics, Uppsala University, Uppsala, Sweden. 3. Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at Sahlgrenska University Hospital, Göteborg, Sweden. 4. Department of Urology, Region of Jönköping, Jönköping, Sweden.
Abstract
OBJECTIVE: To evaluate whether the effects of radical treatment in men with locally advanced prostate cancer (PCa) on PCa mortality observed in randomised clinical trials are applicable on a population basis. PATIENTS AND METHODS: We conducted a population-based cohort study using the Prostate Cancer data Base Sweden of 20 350 men diagnosed between 2000 and 2016 with locally advanced PCa, defined as clinical local stage T3/T4, M0, Mx and a prostate-specific antigen level of <100 ng/mL. Cumulative PCa mortality was examined using competing risk analysis of all men with locally advanced PCa, and also including men who did not undergo radical treatment. Multivariate regression analysis, including prognostic factors, was used to calculate hazard ratios (HRs) for all-cause and PCa-specific death. RESULTS: The proportion of men treated with primary radical radiotherapy (n = 4174) or prostatectomy (n = 1210) increased from 15% in 2000-2003, 25% in 2004-2007, 33% in 2008-2011 to 43% in 2012-2016. The corresponding 5-year PCa mortality decreased from 19%, 18%, 17%, to 15% for all men, with the steepest decrease in men aged 65-74 years, from 16% to 8%. The risk of PCa mortality in men aged <80 years was lower in the last period compared to the first period, with a HR of 0.65 (95% confidence interval 0.56-0.76) in multivariate analysis. CONCLUSIONS: The threefold increase in use of radical treatment was accompanied by a modest decrease in PCa mortality in all men with newly diagnosed locally advanced PCa. For men aged 65-74 years, there was a 50% decrease in the relative risk of PCa death. This indicates that the benefits previously observed in randomised trials can also be achieved in a real-life setting.
OBJECTIVE: To evaluate whether the effects of radical treatment in men with locally advanced prostate cancer (PCa) on PCamortality observed in randomised clinical trials are applicable on a population basis. PATIENTS AND METHODS: We conducted a population-based cohort study using the Prostate Cancer data Base Sweden of 20 350 men diagnosed between 2000 and 2016 with locally advanced PCa, defined as clinical local stage T3/T4, M0, Mx and a prostate-specific antigen level of <100 ng/mL. Cumulative PCamortality was examined using competing risk analysis of all men with locally advanced PCa, and also including men who did not undergo radical treatment. Multivariate regression analysis, including prognostic factors, was used to calculate hazard ratios (HRs) for all-cause and PCa-specific death. RESULTS: The proportion of men treated with primary radical radiotherapy (n = 4174) or prostatectomy (n = 1210) increased from 15% in 2000-2003, 25% in 2004-2007, 33% in 2008-2011 to 43% in 2012-2016. The corresponding 5-year PCamortality decreased from 19%, 18%, 17%, to 15% for all men, with the steepest decrease in men aged 65-74 years, from 16% to 8%. The risk of PCamortality in men aged <80 years was lower in the last period compared to the first period, with a HR of 0.65 (95% confidence interval 0.56-0.76) in multivariate analysis. CONCLUSIONS: The threefold increase in use of radical treatment was accompanied by a modest decrease in PCamortality in all men with newly diagnosed locally advanced PCa. For men aged 65-74 years, there was a 50% decrease in the relative risk of PCadeath. This indicates that the benefits previously observed in randomised trials can also be achieved in a real-life setting.
Authors: Erik Ronmark; Ralf Hoffmann; Viktor Skokic; Maud de Klerk-Starmans; Fredrik Jaderling; Pieter Vos; Maudy C W Gayet; Hans Hofstraat; Marco Janssen; Olof Akre; Per Henrik Vincent Journal: BMJ Health Care Inform Date: 2022-08