Comparison of Surgery and Radiation as Local Treatments in the Risk of Locoregional Complications in Men Subsequently Dying From Prostate Cancer

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IntroductionLate locoregional complications in prostate cancer (PCa) affect quality of life and require medical interventions. Our objective was to compare late locoregional complications in men dying of castration-resistant PCa (CRPC) who previously received external-beam radiotherapy (EBRT) to radical prostatectomy (RP). No group without previous primary local treatment was included.Patients and MethodsThe cohort consists of CRPC patients who died between 2001 and 2013 and who underwent previous EBRT or RP. The Régie de l’assurance maladie du Québec administrative databases were used to identify late locoregional complications (urologic procedures, minor rectal procedures, and other major surgical procedures) and PCa-related hospitalizations occurring in the last 2 years of life. Multivariable logistic regression and negative binomial regression analyses were performed.ResultsThe cohort comprised 1189 patients; 535 (45%) and 654 (55%) received EBRT and RP, respectively. Overall, 46.4% of patients experienced at least 1 late locoregional complication. Primary local treatment type was not associated with the odds of late locoregional complications (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.72, 1.16). RP was associated with greater odds of PCa-related hospitalization (OR, 1.63; 95% CI, 1.23, 2.17) relative to EBRT, as were the usage of a CRPC treatment (OR, 3.96; 95% CI, 2.83, 5.53) and the occurrence of a late locoregional complication (OR, 2.76; 95% CI, 2.05, 3.69). For the number of PCa-related hospitalization days, RP was not found to be significant (rate ratio, 1.09; 95% CI, 0.90, 1.32).ConclusionIn this population-based cohort, the risk of late locoregional complications in CRPC was not associated with the type of primary local treatment (RP or EBRT).Micro-AbstractThis retrospective cohort analysis evaluated late locoregional complications in patients dying of castration-resistant prostate cancer by the type of primary local treatment previously received. Our results suggest that development of locoregional complications was associated with worse survival and more hospitalization days; however, patients previously treated with external-beam radiotherapy were not at greater risk of locoregional complications compared to those treated with radical prostatectomy.

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