Short- and long-term mortality with localized prostate cancer

Abstract

Background: No clear guidelines exist for managing localized prostate cancer because clinical studies have not yet established which treatment provides the best long-term outcome. We assessed the effect of treatment on prostate cancer-specific mortality considering the determinants of treatment and prognosis. Methods: The population-based cohort included all 844 patients having a diagnosis of localized prostate cancer between January 1, 1989, and December 31, 1998, in Geneva, Switzerland. Treatments included prostatectomy (n=158), radiotherapy (n=205), watchful waiting (n=378), hormone therapy (n=72), and other types of therapy (n=31). We compared survival curves using the log-rank test. With multivariate Cox proportional hazards analysis and propensity score methods, we evaluated the independent effect of treatments on prostate cancer-specific mortality. Results: Treatment options only slightly influenced 5-year prostate cancer-specific mortality but had an important effect on long-term mortality. Ten-year specific survival was 83% (95% confidence interval [CI], 73%-93%), 75% (95% CI, 67%-83%), and 72% (95% CI, 66%-80%) for patients who underwent surgery, radiotherapy, and watchful waiting, respectively (P