Background

There are no conclusive results from randomized trials on radiotherapy (RT) versus radical prostatectomy (RP) for prostate cancer. Numerous observational studies have suggested that RP is associated with a lower risk of prostate cancer death, but whether results have been biased due to limited adjustments for confounding factors is unknown.

Objective

To compare the risk of prostate cancer death after RT versus RP.

Design, setting, and participants

Nationwide population-based observational study of men in the Prostate Cancer data Base Sweden 3.0 who had undergone RT or RP between 1998 and 2012.

Outcome measurements and statistical analysis

Prostate cancer deaths were compared. Hazard ratios (HRs) were calculated in Cox regression models, including clinical T stage, M stage, Gleason grade group, serum levels of prostate-specific antigen, proportion of biopsy cores with cancer, mode of detection, comorbidity, age, educational level, and civil status. Period analysis with left truncation was performed.

Results and limitations

Primary treatment was RT or RP for 41 503 men. Treatment effect was associated with disease severity. In univariate analysis of RT versus RP, risk of prostate cancer death was higher after RT—low- and intermediate-risk cancer, HR 1.82 (95% confidence interval [CI]: 1.53–2.16), and high-risk cancer, HR 1.57 (95% CI: 1.33–1.85). After full adjustment in period analysis, this difference between the treatments was attenuated—low- and intermediate-risk cancer, HR 1.24 (95% CI: 0.97–1.58), and high-risk cancer, HR 1.03 (95% CI: 0.81–1.31). Confounding remained due to nonrandom allocation to treatment.

Conclusions

In comparison with previous studies, the difference in prostate cancer mortality after RT and RP was much smaller.

Patient summary

The difference in prostate cancer mortality after contemporary radiotherapy and radical prostatectomy was small in contrast to previous studies, indicating that potential side effects should be more emphasized when selecting treatment.

中文翻译：

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放疗或根治性前列腺切除术后的前列腺癌死亡：基于全国人口的观察性研究

背景

放疗（RT）与根治性前列腺切除术（RP）的前列腺癌随机试验没有结论性的结果。大量的观察性研究表明，RP与前列腺癌死亡的风险较低相关，但是由于混杂因素的有限调整，结果是否存在偏见尚不清楚。

客观的

比较RT和RP后前列腺癌死亡的风险。

设计，设置和参与者

在瑞典前列腺癌数据库瑞典3.0中基于人群的全国人群观察性研究，他们于1998年至2012年间接受了RT或RP治疗。

成果测量和统计分析

比较了前列腺癌的死亡率。在Cox回归模型中计算危险比（HRs），包括临床T期，M期，Gleason分级组，前列腺特异性抗原的血清水平，活检核心与癌症的比例，检测方式，合并症，年龄，教育程度，和公民身份。进行左截短的周期分析。

结果与局限性

41 503名男性的主要治疗是RT或RP。治疗效果与疾病严重程度有关。在RT与RP的单因素分析中，RT后前列腺癌死亡的风险更高-低危和中危癌症，HR 1.82（95％置信区间[CI]：1.53-2.16），高危癌症，HR 1.57 （95％CI：1.33–1.85）。经过对时期分析的全面调整后，治疗之间的差异有所减弱，即低危和中危癌症，HR 1.24（95％CI：0.97–1.58）和高危癌症，HR 1.03（95％CI：0.81– 1.31）。由于分配给治疗的非随机性，导致混淆仍然存在。

结论

与以前的研究相比，RT和RP后前列腺癌死亡率的差异要小得多。

病人总结

与以前的研究相比，当代放疗和根治性前列腺切除术后前列腺癌死亡率的差异很小，这表明在选择治疗方法时应更加强调潜在的副作用。