Abstract
BackgroundTo date, the different treatment modalities for high-risk prostate cancer (Pca) have not been compared in any sufficiently large-scale, prospective, randomized clinical trial. We used propensity-score matching analysis to compare the oncological outcomes of high-risk prostate cancer between patients treated with radical prostatectomy (RP) and those treated with radiation therapy (RT).MethodsWe studied 216 patients who received neoadjuvant therapy followed by RP (RP cohort) and 81 patients who received neoadjuvant androgen-deprivation therapy (ADT) followed by RT (RT cohort). The RP cohort received a luteinizing hormone-releasing hormone agonist and estramustine phosphate (280 mg/day) for 6 months prior to RP. The RT cohort received ADT for at least 6 months prior to RT using a 3-dimensional conformal radiotherapy technique. The total radiation dose was 70 to 76 Gy administered at 2 Gy/fraction.ResultsPropensity-score matching identified 78 matched pairs of patients. The 3-year overall survival rates were 98.3% and 92.1% in the RP and RT groups, respectively (P = 0.156). The 3-year biochemical recurrence-free survival rates were 86.4% and 89.4% in the RP and RT groups, respectively (P = 0.878).ConclusionsOur study findings may suggest almost identical cancer control of RP and RT with appropriate neoadjuvant therapy in high-risk Pca. Therefore, issues of health-related quality of life may have an important impact on decision making in treatment of high-risk Pca.
Highlights
To date, the different treatment modalities for high-risk prostate cancer (Pca) have not been compared in any sufficiently large-scale, prospective, randomized clinical trial
We selected 216 patients who received neoadjuvant therapy followed by radical prostatectomy (RP) and 81 patients who received neoadjuvant androgen-deprivation therapy (ADT) followed by external beam-radiation therapy (EBRT)
We have previously reported the active effect of luteinizing hormone-releasing hormone (LHRH) plus low-dose estramustine phosphate (EMP; LHRH + EMP) for high-risk Pca patients [6]
Summary
The different treatment modalities for high-risk prostate cancer (Pca) have not been compared in any sufficiently large-scale, prospective, randomized clinical trial. We used propensity-score matching analysis to compare the oncological outcomes of high-risk prostate cancer between patients treated with radical prostatectomy (RP) and those treated with radiation therapy (RT). Individuals with prostate-specific antigen (PSA) levels of ≥20 ng/mL, Gleason scores of ≥8, or clinical stage T2c/T3 tumors are defined as high-risk prostate cancer (Pca) patients [1]. Treatment options for high-risk Pca include external beam-radiation therapy (EBRT) with treatment protocols, and reliance on surrogate endpoints [2]. We aimed to evaluate the overall survival (OS) and the biochemical recurrence-free survival (BRFS) rates of high-risk Pca patients who underwent either RP or EBRT using propensity-score matching analyses to adjust for treatment selection bias Several studies comparing Pca treatment options have either overlooked medical comorbidities, because of lack of relevant information [3], or have attempted to control for measured comorbidities using statistical methods [4,5].
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