Radical prostatectomy, external beam radiotherapy, or external beam radiotherapy with brachytherapy boost and disease progression and mortality in patients with gleason score 9-10 prostate cancer

Amar U. Kishan, Ryan R. Cook, Jay P. Ciezki, Ashley E. Ross, Mark M. Pomerantz, Paul L. Nguyen, Talha Shaikh, Phuoc T. Tran, Kiri A. Sandler, Richard G. Stock, Gregory S. Merrick, D. Jeffrey Demanes, Daniel E. Spratt, Eyad I. Abu-Isa, Trude B. Wedde, Wolfgang Lilleby, Daniel J. Krauss, Grace K. Shaw, Ridwan Alam, Chandana A. ReddyAndrew J. Stephenson, Eric A. Klein, Daniel Y. Song, Jeffrey J. Tosoian, John V. Hegde, Sun Mi Yoo, Ryan Fiano, Anthony V. D’Amico, Nicholas G. Nickols, William J. Aronson, Ahmad Sadeghi, Stephen Greco, Curtiland Deville, Todd McNutt, Theodore L. DeWeese, Robert E. Reiter, Johnathan W. Said, Michael L. Steinberg, Eric M. Horwitz, Patrick A. Kupelian, Christopher R. King

Research output: Contribution to journalArticle

Abstract

IMPORTANCE The optimal treatment for Gleason score 9-10 prostate cancer is unknown. OBJECTIVE To compare clinical outcomes of patients with Gleason score 9-10 prostate cancer after definitive treatment. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study in 12 tertiary centers (11 in the United States, 1 in Norway), with 1809 patients treated between 2000 and 2013. EXPOSURES Radical prostatectomy (RP), external beam radiotherapy (EBRT) with androgen deprivation therapy, or EBRT plus brachytherapy boost (EBRT+BT) with androgen deprivation therapy. MAIN OUTCOMES AND MEASURES The primary outcome was prostate cancer–specific mortality; distant metastasis-free survival and overall survival were secondary outcomes. RESULTS Of 1809 men, 639 underwent RP, 734 EBRT, and 436 EBRT+BT. Median ages were 61, 67.7, and 67.5 years; median follow-up was 4.2, 5.1, and 6.3 years, respectively. By 10 years, 91 RP, 186 EBRT, and 90 EBRT+BT patients had died. Adjusted 5-year prostate cancer–specific mortality rates were RP, 12% (95% CI, 8%-17%); EBRT, 13% (95% CI, 8%-19%); and EBRT+BT, 3% (95% CI, 1%-5%). EBRT+BT was associated with significantly lower prostate cancer–specific mortality than either RP or EBRT (cause-specific HRs of 0.38 [95% CI, 0.21-0.68] and 0.41 [95% CI, 0.24-0.71]). Adjusted 5-year incidence rates of distant metastasis were RP, 24% (95% CI, 19%-30%); EBRT, 24% (95% CI, 20%-28%); and EBRT+BT, 8% (95% CI, 5%-11%). EBRT+BT was associated with a significantly lower rate of distant metastasis (propensity-score-adjusted cause-specific HRs of 0.27 [95% CI, 0.17-0.43] for RP and 0.30 [95% CI, 0.19-0.47] for EBRT). Adjusted 7.5-year all-cause mortality rates were RP, 17% (95% CI, 11%-23%); EBRT, 18% (95% CI, 14%-24%); and EBRT+BT, 10% (95% CI, 7%-13%). Within the first 7.5 years of follow-up, EBRT+BT was associated with significantly lower all-cause mortality (cause-specific HRs of 0.66 [95% CI, 0.46-0.96] for RP and 0.61 [95% CI, 0.45-0.84] for EBRT). After the first 7.5 years, the corresponding HRs were 1.16 (95% CI, 0.70-1.92) and 0.87 (95% CI, 0.57-1.32). No significant differences in prostate cancer–specific mortality, distant metastasis, or all-cause mortality (7.5 and >7.5 years) were found between men treated with EBRT or RP (cause-specific HRs of 0.92 [95% CI, 0.67-1.26], 0.90 [95% CI, 0.70-1.14], 1.07 [95% CI, 0.80-1.44], and 1.34 [95% CI, 0.85-2.11]). CONCLUSIONS AND RELEVANCE Among patients with Gleason score 9-10 prostate cancer, treatment with EBRT+BT with androgen deprivation therapy was associated with significantly better prostate cancer–specific mortality and longer time to distant metastasis compared with EBRT with androgen deprivation therapy or with RP.

Original languageEnglish (US)
Pages (from-to)896-905
Number of pages10
JournalJAMA - Journal of the American Medical Association
Volume319
Issue number9
DOIs
StatePublished - Mar 6 2018

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Neoplasm Grading
Brachytherapy
Prostatectomy
Disease Progression
Prostatic Neoplasms
Radiotherapy
Mortality
Prostate
Androgens
Neoplasm Metastasis
Therapeutics

ASJC Scopus subject areas

  • Medicine(all)

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Radical prostatectomy, external beam radiotherapy, or external beam radiotherapy with brachytherapy boost and disease progression and mortality in patients with gleason score 9-10 prostate cancer. / Kishan, Amar U.; Cook, Ryan R.; Ciezki, Jay P.; Ross, Ashley E.; Pomerantz, Mark M.; Nguyen, Paul L.; Shaikh, Talha; Tran, Phuoc T.; Sandler, Kiri A.; Stock, Richard G.; Merrick, Gregory S.; Demanes, D. Jeffrey; Spratt, Daniel E.; Abu-Isa, Eyad I.; Wedde, Trude B.; Lilleby, Wolfgang; Krauss, Daniel J.; Shaw, Grace K.; Alam, Ridwan; Reddy, Chandana A.; Stephenson, Andrew J.; Klein, Eric A.; Song, Daniel Y.; Tosoian, Jeffrey J.; Hegde, John V.; Yoo, Sun Mi; Fiano, Ryan; D’Amico, Anthony V.; Nickols, Nicholas G.; Aronson, William J.; Sadeghi, Ahmad; Greco, Stephen; Deville, Curtiland; McNutt, Todd; DeWeese, Theodore L.; Reiter, Robert E.; Said, Johnathan W.; Steinberg, Michael L.; Horwitz, Eric M.; Kupelian, Patrick A.; King, Christopher R.

In: JAMA - Journal of the American Medical Association, Vol. 319, No. 9, 06.03.2018, p. 896-905.

Research output: Contribution to journalArticle

Kishan, AU, Cook, RR, Ciezki, JP, Ross, AE, Pomerantz, MM, Nguyen, PL, Shaikh, T, Tran, PT, Sandler, KA, Stock, RG, Merrick, GS, Demanes, DJ, Spratt, DE, Abu-Isa, EI, Wedde, TB, Lilleby, W, Krauss, DJ, Shaw, GK, Alam, R, Reddy, CA, Stephenson, AJ, Klein, EA, Song, DY, Tosoian, JJ, Hegde, JV, Yoo, SM, Fiano, R, D’Amico, AV, Nickols, NG, Aronson, WJ, Sadeghi, A, Greco, S, Deville, C, McNutt, T, DeWeese, TL, Reiter, RE, Said, JW, Steinberg, ML, Horwitz, EM, Kupelian, PA & King, CR 2018, 'Radical prostatectomy, external beam radiotherapy, or external beam radiotherapy with brachytherapy boost and disease progression and mortality in patients with gleason score 9-10 prostate cancer', JAMA - Journal of the American Medical Association, vol. 319, no. 9, pp. 896-905. https://doi.org/10.1001/jama.2018.0587
Kishan, Amar U. ; Cook, Ryan R. ; Ciezki, Jay P. ; Ross, Ashley E. ; Pomerantz, Mark M. ; Nguyen, Paul L. ; Shaikh, Talha ; Tran, Phuoc T. ; Sandler, Kiri A. ; Stock, Richard G. ; Merrick, Gregory S. ; Demanes, D. Jeffrey ; Spratt, Daniel E. ; Abu-Isa, Eyad I. ; Wedde, Trude B. ; Lilleby, Wolfgang ; Krauss, Daniel J. ; Shaw, Grace K. ; Alam, Ridwan ; Reddy, Chandana A. ; Stephenson, Andrew J. ; Klein, Eric A. ; Song, Daniel Y. ; Tosoian, Jeffrey J. ; Hegde, John V. ; Yoo, Sun Mi ; Fiano, Ryan ; D’Amico, Anthony V. ; Nickols, Nicholas G. ; Aronson, William J. ; Sadeghi, Ahmad ; Greco, Stephen ; Deville, Curtiland ; McNutt, Todd ; DeWeese, Theodore L. ; Reiter, Robert E. ; Said, Johnathan W. ; Steinberg, Michael L. ; Horwitz, Eric M. ; Kupelian, Patrick A. ; King, Christopher R. / Radical prostatectomy, external beam radiotherapy, or external beam radiotherapy with brachytherapy boost and disease progression and mortality in patients with gleason score 9-10 prostate cancer. In: JAMA - Journal of the American Medical Association. 2018 ; Vol. 319, No. 9. pp. 896-905.
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title = "Radical prostatectomy, external beam radiotherapy, or external beam radiotherapy with brachytherapy boost and disease progression and mortality in patients with gleason score 9-10 prostate cancer",
abstract = "IMPORTANCE The optimal treatment for Gleason score 9-10 prostate cancer is unknown. OBJECTIVE To compare clinical outcomes of patients with Gleason score 9-10 prostate cancer after definitive treatment. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study in 12 tertiary centers (11 in the United States, 1 in Norway), with 1809 patients treated between 2000 and 2013. EXPOSURES Radical prostatectomy (RP), external beam radiotherapy (EBRT) with androgen deprivation therapy, or EBRT plus brachytherapy boost (EBRT+BT) with androgen deprivation therapy. MAIN OUTCOMES AND MEASURES The primary outcome was prostate cancer–specific mortality; distant metastasis-free survival and overall survival were secondary outcomes. RESULTS Of 1809 men, 639 underwent RP, 734 EBRT, and 436 EBRT+BT. Median ages were 61, 67.7, and 67.5 years; median follow-up was 4.2, 5.1, and 6.3 years, respectively. By 10 years, 91 RP, 186 EBRT, and 90 EBRT+BT patients had died. Adjusted 5-year prostate cancer–specific mortality rates were RP, 12{\%} (95{\%} CI, 8{\%}-17{\%}); EBRT, 13{\%} (95{\%} CI, 8{\%}-19{\%}); and EBRT+BT, 3{\%} (95{\%} CI, 1{\%}-5{\%}). EBRT+BT was associated with significantly lower prostate cancer–specific mortality than either RP or EBRT (cause-specific HRs of 0.38 [95{\%} CI, 0.21-0.68] and 0.41 [95{\%} CI, 0.24-0.71]). Adjusted 5-year incidence rates of distant metastasis were RP, 24{\%} (95{\%} CI, 19{\%}-30{\%}); EBRT, 24{\%} (95{\%} CI, 20{\%}-28{\%}); and EBRT+BT, 8{\%} (95{\%} CI, 5{\%}-11{\%}). EBRT+BT was associated with a significantly lower rate of distant metastasis (propensity-score-adjusted cause-specific HRs of 0.27 [95{\%} CI, 0.17-0.43] for RP and 0.30 [95{\%} CI, 0.19-0.47] for EBRT). Adjusted 7.5-year all-cause mortality rates were RP, 17{\%} (95{\%} CI, 11{\%}-23{\%}); EBRT, 18{\%} (95{\%} CI, 14{\%}-24{\%}); and EBRT+BT, 10{\%} (95{\%} CI, 7{\%}-13{\%}). Within the first 7.5 years of follow-up, EBRT+BT was associated with significantly lower all-cause mortality (cause-specific HRs of 0.66 [95{\%} CI, 0.46-0.96] for RP and 0.61 [95{\%} CI, 0.45-0.84] for EBRT). After the first 7.5 years, the corresponding HRs were 1.16 (95{\%} CI, 0.70-1.92) and 0.87 (95{\%} CI, 0.57-1.32). No significant differences in prostate cancer–specific mortality, distant metastasis, or all-cause mortality (7.5 and >7.5 years) were found between men treated with EBRT or RP (cause-specific HRs of 0.92 [95{\%} CI, 0.67-1.26], 0.90 [95{\%} CI, 0.70-1.14], 1.07 [95{\%} CI, 0.80-1.44], and 1.34 [95{\%} CI, 0.85-2.11]). CONCLUSIONS AND RELEVANCE Among patients with Gleason score 9-10 prostate cancer, treatment with EBRT+BT with androgen deprivation therapy was associated with significantly better prostate cancer–specific mortality and longer time to distant metastasis compared with EBRT with androgen deprivation therapy or with RP.",
author = "Kishan, {Amar U.} and Cook, {Ryan R.} and Ciezki, {Jay P.} and Ross, {Ashley E.} and Pomerantz, {Mark M.} and Nguyen, {Paul L.} and Talha Shaikh and Tran, {Phuoc T.} and Sandler, {Kiri A.} and Stock, {Richard G.} and Merrick, {Gregory S.} and Demanes, {D. Jeffrey} and Spratt, {Daniel E.} and Abu-Isa, {Eyad I.} and Wedde, {Trude B.} and Wolfgang Lilleby and Krauss, {Daniel J.} and Shaw, {Grace K.} and Ridwan Alam and Reddy, {Chandana A.} and Stephenson, {Andrew J.} and Klein, {Eric A.} and Song, {Daniel Y.} and Tosoian, {Jeffrey J.} and Hegde, {John V.} and Yoo, {Sun Mi} and Ryan Fiano and D’Amico, {Anthony V.} and Nickols, {Nicholas G.} and Aronson, {William J.} and Ahmad Sadeghi and Stephen Greco and Curtiland Deville and Todd McNutt and DeWeese, {Theodore L.} and Reiter, {Robert E.} and Said, {Johnathan W.} and Steinberg, {Michael L.} and Horwitz, {Eric M.} and Kupelian, {Patrick A.} and King, {Christopher R.}",
year = "2018",
month = "3",
day = "6",
doi = "10.1001/jama.2018.0587",
language = "English (US)",
volume = "319",
pages = "896--905",
journal = "JAMA - Journal of the American Medical Association",
issn = "0098-7484",
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}

TY - JOUR

T1 - Radical prostatectomy, external beam radiotherapy, or external beam radiotherapy with brachytherapy boost and disease progression and mortality in patients with gleason score 9-10 prostate cancer

AU - Kishan, Amar U.

AU - Cook, Ryan R.

AU - Ciezki, Jay P.

AU - Ross, Ashley E.

AU - Pomerantz, Mark M.

AU - Nguyen, Paul L.

AU - Shaikh, Talha

AU - Tran, Phuoc T.

AU - Sandler, Kiri A.

AU - Stock, Richard G.

AU - Merrick, Gregory S.

AU - Demanes, D. Jeffrey

AU - Spratt, Daniel E.

AU - Abu-Isa, Eyad I.

AU - Wedde, Trude B.

AU - Lilleby, Wolfgang

AU - Krauss, Daniel J.

AU - Shaw, Grace K.

AU - Alam, Ridwan

AU - Reddy, Chandana A.

AU - Stephenson, Andrew J.

AU - Klein, Eric A.

AU - Song, Daniel Y.

AU - Tosoian, Jeffrey J.

AU - Hegde, John V.

AU - Yoo, Sun Mi

AU - Fiano, Ryan

AU - D’Amico, Anthony V.

AU - Nickols, Nicholas G.

AU - Aronson, William J.

AU - Sadeghi, Ahmad

AU - Greco, Stephen

AU - Deville, Curtiland

AU - McNutt, Todd

AU - DeWeese, Theodore L.

AU - Reiter, Robert E.

AU - Said, Johnathan W.

AU - Steinberg, Michael L.

AU - Horwitz, Eric M.

AU - Kupelian, Patrick A.

AU - King, Christopher R.

PY - 2018/3/6

Y1 - 2018/3/6

N2 - IMPORTANCE The optimal treatment for Gleason score 9-10 prostate cancer is unknown. OBJECTIVE To compare clinical outcomes of patients with Gleason score 9-10 prostate cancer after definitive treatment. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study in 12 tertiary centers (11 in the United States, 1 in Norway), with 1809 patients treated between 2000 and 2013. EXPOSURES Radical prostatectomy (RP), external beam radiotherapy (EBRT) with androgen deprivation therapy, or EBRT plus brachytherapy boost (EBRT+BT) with androgen deprivation therapy. MAIN OUTCOMES AND MEASURES The primary outcome was prostate cancer–specific mortality; distant metastasis-free survival and overall survival were secondary outcomes. RESULTS Of 1809 men, 639 underwent RP, 734 EBRT, and 436 EBRT+BT. Median ages were 61, 67.7, and 67.5 years; median follow-up was 4.2, 5.1, and 6.3 years, respectively. By 10 years, 91 RP, 186 EBRT, and 90 EBRT+BT patients had died. Adjusted 5-year prostate cancer–specific mortality rates were RP, 12% (95% CI, 8%-17%); EBRT, 13% (95% CI, 8%-19%); and EBRT+BT, 3% (95% CI, 1%-5%). EBRT+BT was associated with significantly lower prostate cancer–specific mortality than either RP or EBRT (cause-specific HRs of 0.38 [95% CI, 0.21-0.68] and 0.41 [95% CI, 0.24-0.71]). Adjusted 5-year incidence rates of distant metastasis were RP, 24% (95% CI, 19%-30%); EBRT, 24% (95% CI, 20%-28%); and EBRT+BT, 8% (95% CI, 5%-11%). EBRT+BT was associated with a significantly lower rate of distant metastasis (propensity-score-adjusted cause-specific HRs of 0.27 [95% CI, 0.17-0.43] for RP and 0.30 [95% CI, 0.19-0.47] for EBRT). Adjusted 7.5-year all-cause mortality rates were RP, 17% (95% CI, 11%-23%); EBRT, 18% (95% CI, 14%-24%); and EBRT+BT, 10% (95% CI, 7%-13%). Within the first 7.5 years of follow-up, EBRT+BT was associated with significantly lower all-cause mortality (cause-specific HRs of 0.66 [95% CI, 0.46-0.96] for RP and 0.61 [95% CI, 0.45-0.84] for EBRT). After the first 7.5 years, the corresponding HRs were 1.16 (95% CI, 0.70-1.92) and 0.87 (95% CI, 0.57-1.32). No significant differences in prostate cancer–specific mortality, distant metastasis, or all-cause mortality (7.5 and >7.5 years) were found between men treated with EBRT or RP (cause-specific HRs of 0.92 [95% CI, 0.67-1.26], 0.90 [95% CI, 0.70-1.14], 1.07 [95% CI, 0.80-1.44], and 1.34 [95% CI, 0.85-2.11]). CONCLUSIONS AND RELEVANCE Among patients with Gleason score 9-10 prostate cancer, treatment with EBRT+BT with androgen deprivation therapy was associated with significantly better prostate cancer–specific mortality and longer time to distant metastasis compared with EBRT with androgen deprivation therapy or with RP.

AB - IMPORTANCE The optimal treatment for Gleason score 9-10 prostate cancer is unknown. OBJECTIVE To compare clinical outcomes of patients with Gleason score 9-10 prostate cancer after definitive treatment. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study in 12 tertiary centers (11 in the United States, 1 in Norway), with 1809 patients treated between 2000 and 2013. EXPOSURES Radical prostatectomy (RP), external beam radiotherapy (EBRT) with androgen deprivation therapy, or EBRT plus brachytherapy boost (EBRT+BT) with androgen deprivation therapy. MAIN OUTCOMES AND MEASURES The primary outcome was prostate cancer–specific mortality; distant metastasis-free survival and overall survival were secondary outcomes. RESULTS Of 1809 men, 639 underwent RP, 734 EBRT, and 436 EBRT+BT. Median ages were 61, 67.7, and 67.5 years; median follow-up was 4.2, 5.1, and 6.3 years, respectively. By 10 years, 91 RP, 186 EBRT, and 90 EBRT+BT patients had died. Adjusted 5-year prostate cancer–specific mortality rates were RP, 12% (95% CI, 8%-17%); EBRT, 13% (95% CI, 8%-19%); and EBRT+BT, 3% (95% CI, 1%-5%). EBRT+BT was associated with significantly lower prostate cancer–specific mortality than either RP or EBRT (cause-specific HRs of 0.38 [95% CI, 0.21-0.68] and 0.41 [95% CI, 0.24-0.71]). Adjusted 5-year incidence rates of distant metastasis were RP, 24% (95% CI, 19%-30%); EBRT, 24% (95% CI, 20%-28%); and EBRT+BT, 8% (95% CI, 5%-11%). EBRT+BT was associated with a significantly lower rate of distant metastasis (propensity-score-adjusted cause-specific HRs of 0.27 [95% CI, 0.17-0.43] for RP and 0.30 [95% CI, 0.19-0.47] for EBRT). Adjusted 7.5-year all-cause mortality rates were RP, 17% (95% CI, 11%-23%); EBRT, 18% (95% CI, 14%-24%); and EBRT+BT, 10% (95% CI, 7%-13%). Within the first 7.5 years of follow-up, EBRT+BT was associated with significantly lower all-cause mortality (cause-specific HRs of 0.66 [95% CI, 0.46-0.96] for RP and 0.61 [95% CI, 0.45-0.84] for EBRT). After the first 7.5 years, the corresponding HRs were 1.16 (95% CI, 0.70-1.92) and 0.87 (95% CI, 0.57-1.32). No significant differences in prostate cancer–specific mortality, distant metastasis, or all-cause mortality (7.5 and >7.5 years) were found between men treated with EBRT or RP (cause-specific HRs of 0.92 [95% CI, 0.67-1.26], 0.90 [95% CI, 0.70-1.14], 1.07 [95% CI, 0.80-1.44], and 1.34 [95% CI, 0.85-2.11]). CONCLUSIONS AND RELEVANCE Among patients with Gleason score 9-10 prostate cancer, treatment with EBRT+BT with androgen deprivation therapy was associated with significantly better prostate cancer–specific mortality and longer time to distant metastasis compared with EBRT with androgen deprivation therapy or with RP.

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