Risk for hospitalization after surgery or radiation therapy for localized prostate cancer

According to a newly published article in BJU International, there was little to no major difference in the risks for hospitalization within 1 year after first-line treatment among relatively healthy, Medicare-eligible men with localized prostate cancer treated by either radical surgery or radiation therapy.

The new paper by Williams et al. (also discussed in a commentary on the Renal & Urology News web site) is based on data from just under 30,000 men, all aged between 66 and 75 years of age who had no significant, known co-morbidities at the time of their treatment for localized prostate cancer. The data are all extracted from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database (explaining why all patients were at least 66 years of age) and all patients were treated between 2004 and 2009.

Williams et al. were interested in comparing the rates of all cause and toxicity-related hospitalization for these patients within 1 year of first-line treatment for their prostate cancer and the associated costs of hospitalization.The types of surgery included open, minimally invasive (i.e., robot-assisted or laparoscopic), and transperineal surgery; the types of radiation therapy included external beam radiation therapy, brachytherapy, or a combination of the two (either with or without androgen deprivation therapy).

Here, in short, are their key findings:

  • Compared to the patients who had first-line radiation therapy, the patients who had first-line surgery were
    • 20 percent less likely to be hospitalized for any cause following therapy (odds ration [OR] = 0.80)
    • 15 percent more likely to be hospitalized for treatment-related complications (OR = 1.15: 95% CI, 1.03-1.29)
  • Compared to the patients who had first-line surgery, the patients who had external beam radiotherapy or IMRT were
    • 16 percent less likely to be hospitalized for treatment-related complications (OR = 0.84)
  • The average (mean) hospitalization costs for patients with treatment-related complications following radiotherapy ($18,381) were significantly higher than those for patients who had complications after surgery ($13,203).

Williams et al. stated that

These findings support prior studies confirming decreased side effect profile associated with three-dimensional conformal radiotherapy and IMRT

and further concluded that:

With the exception of men who underwent external beam radiotherapy/IMRT, there was no statistically significant difference in the odds of hospitalization from treatment-related complications. Costs from hospitalization after treatment were significantly higher for men undergoing radiation therapy than surgery.

However, we should also note that PSA data and the long-term risks of hospitalization for treatment-related complications and side effects (beyond 1 year) were not assessed or evaluated in thsi study.

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