Is Primary Androgen Deprivation Therapy a Suitable Option for Asian Patients With Prostate Cancer Compared With Radical Prostatectomy?

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Background: We conducted a comparative survival analysis between primary androgen deprivation therapy (PADT) and radical prostatectomy (RP) based on nationwide Korean population data that included all patients with prostate cancer. Materials and Methods: This study enrolled 4,538 patients with prostate cancer from the National Health Insurance Service (NHIS) database linked with Korean Central Cancer Registry data who were treated with PADT or RP between January 1, 2007, and December 31, 2014. Kaplan-Meier and multivariate survival analyses stratified by stage (localized and locally advanced) and age (<75 and ≥75 years) were performed using a Cox proportional hazards model to evaluate treatment effects. Results: Among 18,403 patients from the NHIS database diagnosed with prostate cancer during the study period, 4,538 satisfied inclusion criteria and were included in the analyses. Of these, 3,136 and 1,402 patients underwent RP or received PADT, respectively. Risk of death was significantly increased for patients who received PADT compared with those who underwent RP in the propensity score–matched cohort. In subgroup analyses stratified by stage and age, in every subgroup, patients who received PADT had a significantly increased risk of death compared with those who underwent RP. In particular, a much greater risk was observed for patients with locally advanced prostate cancer. Conclusions: Based on a nationwide survival analysis of nonmetastatic prostate cancer, this study provides valuable clinical implications that favor RP over PDAT for treatment of Asian populations. However, the possibility that survival differences have been overestimated due to not accounting for potential confounding characteristics must be considered.

Submitted April 13, 2018; accepted for publication December 20, 2018.

Author contributions: Study concept and design: Ha, J.B. Choi, E. Park, Ahn, J.Y. Lee. Sample recruitment: Shim, M. Kang, S. Kang, J. Park, Yang, I. Choi, Kwak, Jeong, Kim, Byun, Seo, H.M. Lee, S.J. Lee, S.H. Lee, Chung. Data analysis: Shim, M. Kang, E. Park, S. Kang, J. Park, Yang, I. Choi. Manuscript preparation: Ha, J.B. Choi, E. Park, J.Y. Lee. Critical revision and final approval: All authors.

Disclosures: The authors have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: Supported by the National Evidence-based Healthcare Collaborating Agency (NECA), which is funded by the Ministry of Health and Welfare (NC16-003 [J.Y.L.]), and the Bio & Medical Technology Development Program of the National Research Foundation (NRF), which is funded by the Korean government (MSIT) (NRF-2017M3A9B8069577 [J.Y.L.]).

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Correspondence: Ji Youl Lee, MD, PhD, Department of Urology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea. Email:

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