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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

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Surgery v Radiation in Prostate Cancer

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  1. Surgery v Radiation in Prostate Cancer Prasanna Sooriakumaran MD PhD & Peter Wiklund MD PhD

  2. 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

  3. 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

  4. Methods • 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

  5. 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

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