Real-world clinical outcomes of patients with localized prostate cancer treated with radical prostatectomy in SEER-Medicare
Publication: Journal of Comparative Effectiveness Research
Abstract
Aim: This study examined the clinical outcomes of patients in the US with low/intermediate-risk localized prostate cancer (LIR-LPC) and high-risk localized prostate cancer (HR-LPC) who received radical prostatectomy (RP) as initial treatment. Materials & methods: This is a retrospective analysis of the SEER-Medicare database. Patients newly diagnosed with LPC at age of ≥65 years during 2012–2019 who underwent RP as initial definitive treatment and had continuous Medicare Fee-For-Service for ≥12 months prior to RP were included. Eligible patients were stratified into LIR-LPC and HR-LPC cohorts. Overall survival, metastatic free survival and time to advanced prostate cancer treatment (TTAT) were described and compared using the Kaplan–Meier method and Cox proportional-hazards model. Results: The LIR-LPC cohort (n = 4120) and the HR-LPC cohort (n = 5359) had comparable socio-demographic characteristics, with a mean age of approximately 70 years. Survival analysis showed that HR-LPC was associated with significantly shorter overall survival, metastatic free survival and TTAT than LIR-LPC (log rank p < 0.001). After adjusting for comprehensive socio-demographic and baseline clinical characteristics, patients with HR-LPC had an approximately 70% increased risk for all-cause death (hazard ratio [HR]: 1.72; confidence interval [CI]:1.39–2.12), 2.5-fold increased risk for metastasis or death (HR: 2.57; CI: 2.14–3.09), and ninefold increased risk for initiating advanced treatments (HR: 9.06; CI: 6.22–13.18) compared with patients with LIR-LPC. Conclusion: In patients with LPC who received RP as initial definitive treatment, high risk is strongly associated with suboptimal clinical outcomes. Novel therapeutic approaches are needed to enhance the management and improve the outcomes for this patient population.
Plain language summary: Real-world clinical outcomes after radical prostatectomy for localized prostate cancer
What is this article about?
Prostate cancer is the second most common cancer among men in the US. Most new cases are diagnosed at an early stage, when the cancer is still limited to the prostate, known as localized prostate cancer (LPC). Radical prostatectomy (RP) is one of the most often used initial treatments. However, the clinical outcomes are not expected to be the same depending on the risk classifications. This study examined long-term clinical outcomes among more than 9000 Medicare beneficiaries who were newly diagnosed with LPC between 2012 and 2019 and received RP as initial definitive treatment. Patients were divided into two cohorts of low/intermediate-risk (LIR-LPC) and high-risk localized prostate cancer (HR-LPC), respectively. Their clinical outcomes were compared with regards to overall survival, metastasis-free survival and time to advanced prostate cancer treatment (TTAT).
What were the results?
The study found that patients with HR-LPC had significantly worse outcomes than patients with LIR-LPC even after adjusting for comprehensive socio-demographic and clinical characteristics. High risk is associated with a 70% increased risk for all-cause death, 2.5-fold increased risk for metastasis or death and ninefold increased risk for initiating advanced treatments.
What do the results mean?
These findings suggest that current treatment strategies are inadequate for patients with HR-LPC. New treatments and enhanced clinical management are needed to improve care for HR patients.
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© 2026 Johnson & Johnson. This work is licensed under the Attribution-NonCommercial-NoDerivatives 4.0 Unported License
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Received: 30 January 2025
Accepted: 12 January 2026
Published online: 16 February 2026
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Real-world clinical outcomes of patients with localized prostate cancer treated with radical prostatectomy in SEER-Medicare. (2026) Journal of Comparative Effectiveness Research. DOI: 10.57264/cer-2025-0004
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