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Cancer-Specific Mortality After Surgery or Radiation for Patients With Clinically Localized Prostate Cancer Managed During the Prostate-Specific Antigen Era

Anthony V. D’Amico, Judd Moul, Peter R. Carroll, Leon Sun, Deborah Lubeck, Ming-Hui Chen

From the Department of Radiation Oncology, Brigham and Women’s Hospital and Dana-Farber Cancer Institute, Boston, MA; Department of Surgery and Urology Service, Center for Prostate Disease Research, Uniformed Service University and Walter Reed Army Medical Center, Rockville, MD; Department of Urology, University of California, San Francisco, CA; and Department of Statistics, University of Connecticut, Storrs, CT.

Address reprint requests to Anthony V. D’Amico, MD, PhD, Brigham and Women’s Hospital, Department of Radiation Oncology, 75 Francis St, L-2 Level, Boston, MA 02215; email: adamico{at}lroc.harvard.edu.

Purpose: To determine whether pretreatment risk groups shown to predict time to prostate cancer–specific mortality (PCSM) after treatment at a single institution retained that ability in a multi-institutional setting.

Patients and Methods: From 1988 to 2002, 7,316 patients treated in the United States at 44 institutions with either surgery (n = 4,946) or radiation (n = 2,370) for clinical stage T1c-2, N0 or NX, M0 prostate cancer made up the study cohort. A Cox regression analysis was performed to determine the ability of pretreatment risk groups to predict time to PCSM after treatment. The relative risk (RR) of PCSM and 95% confidence intervals (CIs) were calculated for the intermediate- and high-risk groups relative to the low-risk group.

Results: Estimates of non-PCSM 8 years after prostate-specific antigen (PSA) failure were 4% v 15% (surgery versus radiation; P_{log rank} = .002) compared with 13% v 18% (surgery versus radiation; P_{log rank} = .35) for patients whose age at the time of PSA failure was less than 70 as compared with 70 years, respectively. The RR of PCSM after treatment for surgery-managed patients with high- or intermediate-risk disease was 14.2 (95% CI, 5.0 to 23.4; P_Cox < .0001) and 4.9 (95% CI, 1.7 to 8.1; P_Cox = .0037), respectively. These values were 14.3 (95% CI, 5.2 to 24.0; P_Cox < .0001) and 5.6 (95% CI, 2.0 to 9.3; P_Cox = .0012) for radiation-managed patients.

Conclusion: This study provided evidence to support the prediction of time to PCSM after surgery or radiation on the basis of pretreatment risk groups for patients with clinically localized prostate cancer managed during the PSA era.

Supported in part by the Department of Defense Center for Prostate Disease Research funded by the United States Army Medical Research and Material Command, Fort Detrick, MD. Cancer of the Prostate Strategic Urologic Research Endeavor is sponsored by TAP Pharmaceuticals Products Inc, Lake Forest, IL, and managed by the Urology Outcomes Research Group at the University of California, San Francisco, CA.

The opinions and assertions contained herein are the private views of the authors and are not to be construed as reflecting the views of the United States Army or Department of Defense.

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