348 Neoadjuvant luteinizing-hormone-releasing hormone agonist plus estramustine phosphate in high-risk prostate cancer patients: A propensity score analysis

BackgroundIntensity modulated radiation therapy (IMRT) combined with androgen deprivation therapy (ADT) has become the standard treatment for patients with high-risk prostate cancer. Two techniques of rotational IMRT are commonly used in this indication: Volumetric Modulated Arc Therapy (VMAT) and helical tomotherapy (HT). To the best of our knowledge, no study has compared their related costs and clinical effectiveness and/or toxicity in prostate cancer. We aimed to assess differences in costs and toxicity between VMAT and HT in patients with high-risk prostate cancer with pelvic irradiation.Material and MethodsWe used data from the “RCMI pelvis” prospective multicenter study (NCT01325961) including 155 patients. We used a micro-costing methodology to identify cost differences between VMAT and HT. To assess the effects of the two techniques on total actual costs per patient and on toxicity we used stabilized inverse probability of treatment weighting.ResultsThe mean total cost for HT, €2019 3,069 (95% CI, 2,885–3,285) was significantly higher than the mean cost for VMAT €2019 2,544 (95% CI, 2,443–2,651) (p <.0001). The mean ± SD labor and accelerator cost for HT was €2880 (± 583) and €1978 (± 475) for VMAT, with 81 and 76% for accelerator, respectively. Acute GI and GU toxicity were more frequent in VMAT than in HT (p = .021 and p = .042, respectively). Late toxicity no longer differed between the two groups up to 24 months after completion of treatment.ConclusionUse of VMAT was associated with lower costs for IMRT planning and treatment than HT. Similar stabilized long-term toxicity was reported in both groups after higher acute GI and GU toxicity in VMAT. The estimates provided can benefit future modeling work like cost-effectiveness analysis.

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PE11: Role of robotic radical prostatectomy in hormonal therapy for high-risk prostate cancer: A propensity score-adjusted analysis

European Urology Supplements ◽

10.1016/s1569-9056(14)50202-3 ◽

2014 ◽

Vol 13 (3) ◽

pp. 19

Author(s):

W.S. Ham ◽

S.H. Lee ◽

K.C. Koo

Keyword(s):

Prostate Cancer ◽

High Risk ◽

Radical Prostatectomy ◽

Propensity Score ◽

Hormonal Therapy ◽

Robotic Radical Prostatectomy ◽

Adjusted Analysis ◽

High Risk Prostate Cancer ◽

Risk Prostate Cancer

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Association between primary surgery and all-cause mortality among elderly patients with high-risk prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.6_suppl.e576 ◽

2017 ◽

Vol 35 (6_suppl) ◽

pp. e576-e576

Author(s):

Sumedha Chhatre ◽

David Inkoo Lee ◽

Doyeong Yu ◽

S. Bruce Malkowicz ◽

Ravishankar Jayadevappa

Keyword(s):

Prostate Cancer ◽

Radiation Therapy ◽

High Risk ◽

Propensity Score ◽

Curative Intent ◽

High Risk Prostate Cancer ◽

Primary Surgery ◽

All Cause Mortality ◽

Risk Prostate Cancer

e576 Background: To determine the five year survival impact of primary surgery compared to radiation therapy in older men with high risk prostate cancer. Methods: This was a population-based cohort study using Surveillance, Epidemiology, and End Results (SEER)-Medicare patients 66 years or older, diagnosed for prostate cancer between 2004 and 2008. High-risk prostate cancer was identified as Gleason score of ≥ 8, or clinical stage T3a. Treatments studied were definitive local (curative intent) therapy (surgery or radiation therapy) within 180 days of prostate cancer diagnosis. The two treatment groups were retrospectively followed for one-year pre and five years post diagnosis. Main outcome measure was five-year all-cause mortality and cancer specific mortality. Sequential Cox regression was used to assess the hazard of mortality associated with surgery, compared to radiation therapy, after adjusting for socio-demographic variables, variables and propensity score. Results: We identified a cohort of 24,838 men newly diagnosed for high-risk for prostate cancer between 2004 and 2008. Forty-seven percent of these had surgery (n = 11,696) as well as radiation therapy (n = 11,724) as a primary treatment with curative intent within 180 days of diagnosis. Mean age at diagnosis of radiation therapy group was higher compared to surgery group (73.5, sd = 5.3 vs. 70.3, sd = 4.9; p = 0.020). Radiation group had higher comorbidity compared to surgery group (37% vs. 26%, p = 0.0316). Unadjusted all-cause mortality comparison over five years of follow-up showed that surgery treatment was associated with lower mortality (HR = 0.58, CI = 0.54, 0.62). After adjusting for propensity score, the hazard of all-cause five year mortality remained lower for surgery compared to radiation therapy (HR = 0.86, CI = 0.78, 9.4). Conclusions: Over a five-year follow-up, primary surgery was associated with improved survival compared to radiation therapy in high-risk prostate cancer patients. Longer follow-up is needed to determine if the survival advantage of surgery will persist as well as factors contributing to the difference in survival.

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