Long-term Predictions for Radical Prostatectomy versus Watchful Waiting in Early Prostate Cancer: 40-year Period Extrapolation
Author(s)
Neda Alrawashdh, PhD1, Anastasija Martinovic, MS, PharmD2, Karen M. MacDonald, PhD3, Ivo Abraham, PhD1.
1The University of Arizona, Tucson, AZ, USA, 2graduate student, The University of Arizona, Tucson, AZ, USA, 3Matrix 45, LLC, Tucson, AZ, USA.
1The University of Arizona, Tucson, AZ, USA, 2graduate student, The University of Arizona, Tucson, AZ, USA, 3Matrix 45, LLC, Tucson, AZ, USA.
OBJECTIVES: Radical Prostatectomy (RP) and Watchful Waiting (WW) are two strategies used to treat localized prostate cancer. Clinical trials that evaluated benefits of each strategy showed different results and created the necessity of exploring this topic more profoundly. In this study we aimed to extrapolate the Prostate Specific Survival (PSS) curves and Metastasis Free Survival (MFS) curves beyond the end of Scandinavian Prostate Cancer Group Study Number 4 (SPCG-4) clinical trial, up to 40 years of follow up and examine possible differences between two strategies.
METHODS: Published SPCG-4 cumulative incidence curves after 18 years of follow-up for prostate cancer death and metastases were fitted, and survival curves were extrapolated up to 40 years. PSS, MFS, their respective hazard rates, and Hazard Ratio (HR) between the two arms of treatment were estimated. The difference in mean survival gains and Absolute Risk Reduction (ARR) were estimated for each arm. Model was validated against data from SPCG-4 trial published after 23 years of follow-up.
RESULTS: After 40 years, the HR (95%CI) of prostate cancer death was 0.69(0.59-0.86) for all patients; 0.58(0.46-0.85) for patients <65 years; and 0.59(0.29-1.02) for patients ≥65 years when RP compared with WW. The corresponding HRs of metastases were 0.58(0.52-0.66) for all patients; 0.76(0.64-0.98) for patients <65 years; and 0.46(0.35-0.64) for patients ≥65 years. The ARR (95%CI) for PSS and MFS were, respectively, 15.26(10.76-19.65) and 20.79(16.59-23.21) for all ages; 21.30(11.42-28.36) and 17.89(10.73-22.69) for patients <65 years; and 10.03(-4.16-30.16) and 24.19(13.42-30.64) for patients ≥65 years. Across 40 years, RP patients gained on average 3.99(3.70-4.18) years without prostate cancer death, and 5.16(4.79-5.29) with metastatic free status.
CONCLUSIONS: Extrapolated up to 40 years of follow up, RP shows better gains in PSS and MFS compared to WW. These findings might help facilitate decision making processes for patients with localized prostate cancer.
METHODS: Published SPCG-4 cumulative incidence curves after 18 years of follow-up for prostate cancer death and metastases were fitted, and survival curves were extrapolated up to 40 years. PSS, MFS, their respective hazard rates, and Hazard Ratio (HR) between the two arms of treatment were estimated. The difference in mean survival gains and Absolute Risk Reduction (ARR) were estimated for each arm. Model was validated against data from SPCG-4 trial published after 23 years of follow-up.
RESULTS: After 40 years, the HR (95%CI) of prostate cancer death was 0.69(0.59-0.86) for all patients; 0.58(0.46-0.85) for patients <65 years; and 0.59(0.29-1.02) for patients ≥65 years when RP compared with WW. The corresponding HRs of metastases were 0.58(0.52-0.66) for all patients; 0.76(0.64-0.98) for patients <65 years; and 0.46(0.35-0.64) for patients ≥65 years. The ARR (95%CI) for PSS and MFS were, respectively, 15.26(10.76-19.65) and 20.79(16.59-23.21) for all ages; 21.30(11.42-28.36) and 17.89(10.73-22.69) for patients <65 years; and 10.03(-4.16-30.16) and 24.19(13.42-30.64) for patients ≥65 years. Across 40 years, RP patients gained on average 3.99(3.70-4.18) years without prostate cancer death, and 5.16(4.79-5.29) with metastatic free status.
CONCLUSIONS: Extrapolated up to 40 years of follow up, RP shows better gains in PSS and MFS compared to WW. These findings might help facilitate decision making processes for patients with localized prostate cancer.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
HTA24
Topic
Health Technology Assessment
Disease
SDC: Oncology, SDC: Urinary/Kidney Disorders