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Trends and outcome from radical therapy for primary non-metastatic prostate cancer in a UK population
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Greenberg, David C., Lophatananon, Artitaya, Wright, Karen A., Muir, Kenneth (Kenneth R.) and Gnanapragasam, Vincent J. (2015) Trends and outcome from radical therapy for primary non-metastatic prostate cancer in a UK population. PLoS One, Volume 10 (Number 3). pp. 1-12. Article number e0119494. doi:10.1371/journal.pone.0119494
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Official URL: http://dx.doi.org/10.1371/journal.pone.0119494
Abstract
Background:
Increasing proportions of men diagnosed with prostate cancer in the UK are presenting with non-metastatic disease. We investigated how treatment trends in this demographic have changed.
Patient and Methods:
Non-metastatic cancers diagnosed from 2000–2010 in the UK Anglian Cancer network stratified by age and risk group were analysed [n = 10,365]. Radiotherapy [RT] and prostatectomy [RP] cancer specific survival [CSS] were further compared [n = 4755].
Results:
Over the decade we observed a fall in uptake of primary androgen deprivation therapy but a rise in conservative management [CM] and radical therapy [p<0.0001]. CM in particular has become the primary management for low-risk disease by the decade end [p<0.0001]. In high-risk disease however both RP and RT uptake increased significantly but in an age dependent manner [p<0.0001]. Principally, increased RP in younger men and increased RT in men ≥ 70y. In multivariate analysis of radically treated men both high-risk disease [HR 8.0 [2.9–22.2], p<0.0001] and use of RT [HR 1.9 [1.0–3.3], p = 0.024] were significant predictors of a poorer CSM. In age-stratified analysis however, the trend to benefit of RP over RT was seen only in younger men [≤ 60 years] with high-risk disease [p = 0.07]. The numbers needed to treat by RP instead of RT to save one cancer death was 19 for this group but 67 for the overall cohort.
Conclusion:
This study has identified significant shifts in non-metastatic prostate cancer management over the last decade. Low-risk disease is now primarily managed by CM while high-risk disease is increasingly treated radically. Treatment of high-risk younger men by RP is supported by evidence of better CSM but this benefit is not evident in older men.
| Item Type: | Journal Article | ||||||||
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| Subjects: | R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer) | ||||||||
| Divisions: | Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School > Health Sciences > Statistics and Epidemiology Faculty of Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Prostate -- Cancer -- Treatment | ||||||||
| Journal or Publication Title: | PLoS One | ||||||||
| Publisher: | Public Library of Science | ||||||||
| ISSN: | 1932-6203 | ||||||||
| Official Date: | 5 March 2015 | ||||||||
| Dates: |
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| Volume: | Volume 10 | ||||||||
| Number: | Number 3 | ||||||||
| Number of Pages: | 12 | ||||||||
| Page Range: | pp. 1-12 | ||||||||
| Article Number: | Article number e0119494 | ||||||||
| DOI: | 10.1371/journal.pone.0119494 | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Access rights to Published version: | Open Access |
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