Outcomes following radical prostatectomy or external beam radiation for veterans with Gleason 9 and 10 prostate cancer
Abstract Background The optimal upfront treatment modality for patients with nonmetastatic Gleason Score 9 and 10 prostate cancer (GS 9–10 PCa) is unknown. Methods We conducted a retrospective cohort study of patients in the Veterans Health Administration (VHA) with GS 9–10 PCa treated with radical...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2022-08-01
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| Series: | Cancer Medicine |
| Online Access: | https://doi.org/10.1002/cam4.4656 |
| _version_ | 1811309346339946496 |
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| author | Hann‐Hsiang Chao Payal D. Soni Bassam Dahman Spiro C. Stilianoudakis Hampton Ford Raj Singh Stephen J. Freedland Drew Moghanaki Neha Vapiwala Michael G. Chang |
| author_facet | Hann‐Hsiang Chao Payal D. Soni Bassam Dahman Spiro C. Stilianoudakis Hampton Ford Raj Singh Stephen J. Freedland Drew Moghanaki Neha Vapiwala Michael G. Chang |
| author_sort | Hann‐Hsiang Chao |
| collection | DOAJ |
| description | Abstract Background The optimal upfront treatment modality for patients with nonmetastatic Gleason Score 9 and 10 prostate cancer (GS 9–10 PCa) is unknown. Methods We conducted a retrospective cohort study of patients in the Veterans Health Administration (VHA) with GS 9–10 PCa treated with radical prostatectomy (RP) or external beam radiation therapy with androgen deprivation therapy (EBRT+ADT) from 1/2000 to 12/2010. Outcomes included overall survival (OS), distant metastasis‐free survival (DMFS), and salvage/adjuvant therapy‐free survival (SAFS), as assessed by Kaplan–Meier analysis. Results We identified 1220 veterans with GS 9–10 PCa; 335 were treated with RP, and 885 were treated with EBRT+ADT. With a median follow‐up of 9.9 years, propensity score‐matched analyses demonstrated that RP had superior 10‐year OS (70.8% [RP] vs. 61.2% [EBRT+ADT], p < 0.001), 10‐year DMFS rates were similar between RP (76.7%) and EBRT+ADT (81.0%), and 10‐year SAFS rates were lower for RP vs EBRT + ADT (35.2% [RP] vs. 75.2% [EBRT+ADT], p < 0.001). The receipt of salvage ADT was higher with upfront RP (51.9% vs. 26.1%, p < 0.001), despite receipt of adjuvant/salvage EBRT in 41.8% of RP patients. Among patients treated with RP, there were no differences in outcomes by race. However, higher survival rates were noted among Black patients treated with EBRT+ADT compared with White patients. Conclusions This analysis demonstrated higher 10‐year OS rates among men treated with upfront RP versus EBRT+ADT, though missing confounders and similar DMFS rates suggest the long‐term cause‐specific OS rates may be similar. We also highlight real‐world outcomes of a diverse patient population in the VHA and improved outcomes for Black patients receiving EBRT+ADT. |
| first_indexed | 2024-04-13T09:40:39Z |
| format | Article |
| id | doaj.art-0a7ff5dfc9c54cf9aaf433619ea74a42 |
| institution | Directory Open Access Journal |
| issn | 2045-7634 |
| language | English |
| last_indexed | 2024-04-13T09:40:39Z |
| publishDate | 2022-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cancer Medicine |
| spelling | doaj.art-0a7ff5dfc9c54cf9aaf433619ea74a422022-12-22T02:51:56ZengWileyCancer Medicine2045-76342022-08-0111152886289510.1002/cam4.4656Outcomes following radical prostatectomy or external beam radiation for veterans with Gleason 9 and 10 prostate cancerHann‐Hsiang Chao0Payal D. Soni1Bassam Dahman2Spiro C. Stilianoudakis3Hampton Ford4Raj Singh5Stephen J. Freedland6Drew Moghanaki7Neha Vapiwala8Michael G. Chang9Radiation Oncology Service Hunter Holmes McGuire VA Medical Center Richmond Virginia USARadiation Oncology Service Hunter Holmes McGuire VA Medical Center Richmond Virginia USADepartment of Health Behavior and Policy Virginia Commonwealth University Richmond Virginia USADepartment of Biostatistics Virginia Commonwealth University Richmond Virginia USARadiation Oncology Service Hunter Holmes McGuire VA Medical Center Richmond Virginia USADepartment of Radiation Oncology Virginia Commonwealth University Richmond Virginia USADepartment of Surgery Cedars‐Sinai Medical Center Los Angeles California USARadiation Oncology Service VA Greater Los Angeles Healthcare System Los Angeles California USADepartment of Radiation Oncology University of Pennsylvania Philadelphia Pennsylvania USARadiation Oncology Service Hunter Holmes McGuire VA Medical Center Richmond Virginia USAAbstract Background The optimal upfront treatment modality for patients with nonmetastatic Gleason Score 9 and 10 prostate cancer (GS 9–10 PCa) is unknown. Methods We conducted a retrospective cohort study of patients in the Veterans Health Administration (VHA) with GS 9–10 PCa treated with radical prostatectomy (RP) or external beam radiation therapy with androgen deprivation therapy (EBRT+ADT) from 1/2000 to 12/2010. Outcomes included overall survival (OS), distant metastasis‐free survival (DMFS), and salvage/adjuvant therapy‐free survival (SAFS), as assessed by Kaplan–Meier analysis. Results We identified 1220 veterans with GS 9–10 PCa; 335 were treated with RP, and 885 were treated with EBRT+ADT. With a median follow‐up of 9.9 years, propensity score‐matched analyses demonstrated that RP had superior 10‐year OS (70.8% [RP] vs. 61.2% [EBRT+ADT], p < 0.001), 10‐year DMFS rates were similar between RP (76.7%) and EBRT+ADT (81.0%), and 10‐year SAFS rates were lower for RP vs EBRT + ADT (35.2% [RP] vs. 75.2% [EBRT+ADT], p < 0.001). The receipt of salvage ADT was higher with upfront RP (51.9% vs. 26.1%, p < 0.001), despite receipt of adjuvant/salvage EBRT in 41.8% of RP patients. Among patients treated with RP, there were no differences in outcomes by race. However, higher survival rates were noted among Black patients treated with EBRT+ADT compared with White patients. Conclusions This analysis demonstrated higher 10‐year OS rates among men treated with upfront RP versus EBRT+ADT, though missing confounders and similar DMFS rates suggest the long‐term cause‐specific OS rates may be similar. We also highlight real‐world outcomes of a diverse patient population in the VHA and improved outcomes for Black patients receiving EBRT+ADT.https://doi.org/10.1002/cam4.4656 |
| spellingShingle | Hann‐Hsiang Chao Payal D. Soni Bassam Dahman Spiro C. Stilianoudakis Hampton Ford Raj Singh Stephen J. Freedland Drew Moghanaki Neha Vapiwala Michael G. Chang Outcomes following radical prostatectomy or external beam radiation for veterans with Gleason 9 and 10 prostate cancer Cancer Medicine |
| title | Outcomes following radical prostatectomy or external beam radiation for veterans with Gleason 9 and 10 prostate cancer |
| title_full | Outcomes following radical prostatectomy or external beam radiation for veterans with Gleason 9 and 10 prostate cancer |
| title_fullStr | Outcomes following radical prostatectomy or external beam radiation for veterans with Gleason 9 and 10 prostate cancer |
| title_full_unstemmed | Outcomes following radical prostatectomy or external beam radiation for veterans with Gleason 9 and 10 prostate cancer |
| title_short | Outcomes following radical prostatectomy or external beam radiation for veterans with Gleason 9 and 10 prostate cancer |
| title_sort | outcomes following radical prostatectomy or external beam radiation for veterans with gleason 9 and 10 prostate cancer |
| url | https://doi.org/10.1002/cam4.4656 |
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