Radical prostatectomy improves survival in selected metastatic prostate cancer patients: A North American population‐based study

Objective To test whether radical prostatectomy might result in better survival than external beam radiation therapy in metastatic prostate cancer patients. Methods Newly diagnosed metastatic prostate cancer patients with M1a/b substages, treated with radical prostatectomy or external beam radiation therapy were ed from the Surveillance, Epidemiology and End Results database (2004–2016). Temporal trend analyses, propensity score matching, cumulative incidence plots, multivariate competing risks regression models and landmark analyses were used. Results Of 4280 patients, 954 (22.3%) were treated with radical prostatectomy. After propensity score matching, 5‐year cancer‐specific mortality was 47.0 versus 53.0% in radical prostatectomy versus external beam radiation therapy patients (P = 0.003). In propensity score matched competing risks regression models, radical prostatectomy was associated with lower cancer‐specific mortality versus external beam radiation therapy (hazard ratio 0.79, 95% confidence interval 0.79–0.90; P = 0.001). Finally, landmark analyses rejected the bias favoring radical prostatectomy. Finally, in subgroup analyses, we relied on selection criteria that most closely resembled the STAMPEDE criteria and a similar hazard ratio of 0.8 (P