Early Mortality of Prostatectomy vs. Radiotherapy as a Primary Treatment for Prostate Cancer: A Population-Based Study From the United States and East Germany

Objective: To assess the extent of early mortality and its temporal course after prostatectomy and radiotherapy in the general population. Methods: Data from the Surveillance, Epidemiology, and End Results (SEER) database and East German epidemiologic cancer registries were used for the years 2005–2...

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Published in:Frontiers in oncology Vol. 9; p. 1451
Main Authors: Medenwald, Daniel, Vordermark, Dirk, Dietzel, Christian T.
Format: Journal Article
Language:English
Published: Switzerland Frontiers Media S.A 17.01.2020
Subjects:
early mortality
general population
Oncology
prostate cancer
prostatectomy
radiotherapy
radiotherapy
early mortality
prostatectomy
prostate cancer
general population
ISSN:2234-943X, 2234-943X
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Summary:Objective: To assess the extent of early mortality and its temporal course after prostatectomy and radiotherapy in the general population. Methods: Data from the Surveillance, Epidemiology, and End Results (SEER) database and East German epidemiologic cancer registries were used for the years 2005–2013. Metastasized cases were excluded. Analyzing overall mortality, year-specific Cox regression models were used after adjusting for age (including age squared), risk stage, and grading. To estimate temporal hazards, we computed year-specific conditional hazards for surgery and radiotherapy after propensity-score matching and applied piecewise proportional hazard models. Results: In German and US populations, we observed higher initial 3-month mortality odds for prostatectomy (USA: 9.4, 95% CI: 7.8–11.2; Germany: 9.1, 95% CI: 5.1–16.2) approaching the null effect value not before 24-months (estimated annual mean 36-months in US data) after diagnosis. During the observational period, we observed a constant hazard ratio for the 24-month mortality in the US population (2005: 1.7, 95% CI: 1.5–1.9; 2013: 1.9, 95% CI: 1.6–2.2) comparing surgery and radiotherapy. The same was true in the German cohort (2005: 1.4, 95% CI: 0.9–2.1; 2013: 3.3, 95% CI: 2.2–5.1). Considering low-risk cases, the adverse surgery effect appeared stronger. Conclusion: There is strong evidence from two independent populations of a considerably higher early to midterm mortality after prostatectomy compared to radiotherapy extending the time of early mortality considered by previous studies up to 36-months.
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Edited by: Scott T. Tagawa, Cornell University, United States
This article was submitted to Genitourinary Oncology, a section of the journal Frontiers in Oncology
Reviewed by: Shashwat Sharad, Center for Prostate Disease Research (CPDR), United States; Mohamed Saad Zaghloul, Cairo University, Egypt
ISSN:2234-943X
2234-943X
DOI:10.3389/fonc.2019.01451