Objective
To evaluate whether the effects of radical treatment in men with locally advanced prostate cancer (PCa) on PCa mortality observed in randomized clinical trials are applicable on a population basis.
Patients and methods
We conducted a population‐based cohort study in Prostate Cancer data Base Sweden of 20 350 men diagnosed between 2000‐2016 with locally advanced PCa, defined as clinical local stage T3/T4, M0, Mx and PSA <100 ng/ml. Cumulative PCa mortality was examined by use of competing risk analysis of all men with locally advanced PCa, also including men who did not undergo radical treatment. Multivariate regression analysis including prognostic factors was used to calculate hazard ratios (HR) for all‐cause and PCa‐specific death.
Results
The proportion of men treated with primary radical radiotherapy (n=4 174) or prostatectomy (n=1 210) increased from 15% in 2000‐2003, 25% in 2004‐2007, 33% in 2008‐2011 to 43% in 2012‐2016. The corresponding five‐year PCa mortality decreased from 19%, 18%, 17%, to 15% for all men, with the steepest decrease in men age 65‐74, from 16% to 8%. Risk of PCa mortality in men below 80 was lower in the last period compared to first period, HR 0.65 (95% CI 0.56‐0.76) in multivariate analysis.
Conclusions
The three‐fold increase in use of radical treatment was accompanied by a modest decrease in PCa mortality in all men with newly diagnosed locally advanced PCa. For men age 65‐74, there was a 50% decrease in relative risk of PCa death. This indicates that the benefits previously observed in randomized trials can also be achieved in a real‐life setting.