Comparing the effects of surgery, radiation therapy, and active surveillance on men with localized prostate cancer : : the CEASAR study / David F. Penson, Daniel A. Barocas.

Format:

Book

Author/Creator:

Penson, David F., author.

Barocas, Daniel A., author.

Language:

English

Subjects (All):

Outcome assessment (Medical care).

Physical Description:

1 online resource (1 PDF file (71 pages)) : illustrations

Other Title:

Comparing the effects of surgery, radiation therapy, and active surveillance on men with localized prostate cancer

Place of Publication:

Washington (DC) : Patient-Centered Outcomes Research Institute (PCORI), 2020.

Summary:

BACKGROUND: The 2008 evidence report of the Agency for Healthcare Research and Quality (AHRQ) called for high-quality, prospective cohort studies that identified men at the time of diagnosis of localized prostate cancer (PCa) and collected comprehensive patient, tumor, and treatment selection characteristics to generate critical patient-centered information to aid in decision-making for localized disease. Although new evidence has been generated since 2008 that has advanced the understanding of outcomes following treatment for PCa, the knowledge gap identified in the AHRQ report remains unfilled. OBJECTIVES: (1) Compare the effectiveness of contemporary surgical and radiation techniques for localized PCa; (2) identify patient-level characteristics that may influence comparative effectiveness; and (3) assess how the comparative effectiveness of the different therapies varies by the quality of care received. METHODS: The Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) study is a prospective, population-based observational cohort study of 3269 men younger than age 80 with clinically localized PCa diagnosed in 2011-2012 and enrolled in the study within 6 months of diagnosis. We followed the cohort longitudinally, collecting clinical and key patient-reported outcome data at baseline and at 6, 12, and 36 months after enrollment. In addition, we performed a full medical record review for each participant within a year of enrollment. We used multivariate statistical methods to achieve the proposed specific objectives and standard imputation methods to address missing data. RESULTS: To achieve our first objective, we compared baseline, 6-month, 1-year, and 3-year health-related quality-of-life outcomes in men undergoing surgery, radiotherapy (RT), or active surveillance (AS). The analytic cohort for this analysis contained 2550 men: 1523 (59.9%) radical prostatectomy (RP); 598 (23.6%) external beam radiotherapy (EBRT); and 429 (16.6%) AS. At 3 years, sexual function for men undergoing RP was significantly worse than for those undergoing EBRT (−17.1 points; P < .001). The difference in sexual function between EBRT and AS at 3 years, while statistically significant, was not clinically significant (−5.9 points; P = .023). RP was associated with worse urinary continence scores than EBRT (−18 points; P < .001) or AS (−13.4 points; P < .001). No clinically significant differences in bowel or hormone function were noted. We explored the independent relationship of race on patient-reported outcomes at 1 year and found no significant associations. Similarly, we explored the relationship between commonly used quality of care metrics in PCa and patient-reported outcomes at 1 year and failed to find an association. CONCLUSIONS: Significant differences exist in patient-reported outcomes following modern treatments for localized PCa, and these differences may vary in certain subgroups of patients. Future research should focus on exploring these potential associations and detecting longer-term differences in cancer control between treatments. LIMITATIONS AND SUBPOPULATION CONSIDERATIONS: All observational studies face considerable risk for confounding by indication. We have attempted to control for this risk by using appropriate methods of statistical adjustment and by trying to capture previously unmeasured potential confounders at baseline. Our results may still contain some bias, although probably less than previous studies.

Notes:

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