WASHINGTON, D.C.—Patients with localized prostate cancer (PCa) are more likely to die from any cause and from PCa within three years if they undergo primary androgen deprivation therapy (PADT) rather than radical prostatectomy (RP), a new study indicates.
Researchers used information from the linked Surveillance Epidemiology and End Results (SEER)-Medicare database from 1998 to 2007 to probe the comparative effectiveness of PADT and RP. Using propensity-score matching to control for the most important survival predictors, they determined that PADT was associated with a threefold higher risk of overall mortality and a 12-fold higher risk of PCa-specific mortality within the follow-up period, which averaged 2.87 years for patients who underwent PADT and 2.95 years for RP patients.
“ADT alone is not appropriate for localized PCa patients,” noted lead investigator Jinan Liu, PhD, of HealthCore, Inc., in Wilmington, Del., after presenting the results at the 2012 annual meeting of the International Society for Pharmacoeconomics and Outcomes Research. “The patients should be well informed by their physician about this knowledge before making treatment decision together.”
Dr. Liu and three of his coauthors from Tulane University in New Orleans undertook the study because PADT is commonly used in localized PCa but does not have a solid evidence base behind this treatment. Their analysis focused on patients aged 66-74 years at the time of diagnosis and who had T1 or T2 PCa and no other cancer diagnosis.
The study included 1,624 patients with localized PCa treated with PADT and another 1,624 who underwent RP. The two groups were comparable with respect to Gleason score, Charlson Comorbidity Index score, PSA levels, age, race, and year of treatment initiation.
During the follow-up period, the rates of overall mortality and PCa-specific mortality were 16.38% and 3.69%, respectively, in the PADT group compared with 3.45% and 0.25%, respectively, in the RP group.
Patients who were unmarried or had more comorbidities were the most likely to die. Poor Gleason scores were associated with the highest risk of PCa-specific death.
Dr. Liu noted that the results are congruent with an earlier study he led (Comp Effectiveness Res 2012;2:21-27) showing that, after propensity-score matching, three-year overall survival in localized-PCa was significantly lower with PADT than with RP.