Abstract
BackgroundIt remains controversial if radical prostatectomy or definitive radiation therapy produces equivalent outcomes in high‐risk localized prostate cancer.MethodsWe queried The Surveillance, Epidemiology, and End Results (SEER) database for those who received upfront surgery or who were recommended for surgery but instead received radiation. Inverse probability of treatment weighing was used to adjust for covariate imbalance and the weighted Cox proportional hazards model was used to estimate the effects of treatment groups on survival. A meta‐analysis was performed to pool estimates from published studies.ResultsAmong eligible 62 533 patients, 59 540 had upfront surgery and 2993 patients had upfront radiotherapy. EBRT + BT was associated with a superior cancer‐specific survival (CSS) compared with surgery or EBRT alone (HR, 0.55, 95% CI, 0.3‐1.0; HR, 0.49, 95% CI, 0.24‐0.98, respectively), whereas EBRT was associated with an inferior overall survival (OS) compared with surgery (HR, 1.46, 95% CI, 1.16‐1.8). Radiotherapy (EBRT ± BT) was inferior to surgery by OS (HR, 1.63, 95% CI, 1.13‐2.34) in patients ≤ 65 years, and was superior to surgery by CSS in patients > 65 years (HR, 0.69, 95% CI, 0.49‐0.97). The meta‐analysis showed consistent results.ConclusionEBRT + BT was associated with a significantly better prostate CSS compared with surgery or EBRT. EBRT alone was inferior to surgery by OS.
Highlights
High‐risk prostate cancer, characterized by prostate‐specific antigen (PSA) > 20 ng/mL, Gleason score ≥ 8, or clinical T stage ≥ 3, accounts for approximately 15% of all prostate cancer diagnosis and has significant risk of tumor recurrence and death compared with low/intermediate‐risk cancer.[1,2] Definitive treatment of high‐risk localized prostate cancer consists of radical prostatectomy (RP), external beam radiotherapy (EBRT) alone, or EBRT plus brachytherapy boost (EBRT + BT)
Our study demonstrated that EBRT + BT was associated with a superior cancer‐ specific survival (CSS) compared with surgery or EBRT alone, whereas surgery and EBRT + BT had similar yet superior overall survival (OS) than EBRT
Treatment of EBRT + BT is associated with significantly better outcomes in the high‐risk patient population
Summary
High‐risk prostate cancer, characterized by prostate‐specific antigen (PSA) > 20 ng/mL, Gleason score ≥ 8, or clinical T stage ≥ 3, accounts for approximately 15% of all prostate cancer diagnosis and has significant risk of tumor recurrence and death compared with low/intermediate‐risk cancer.[1,2] Definitive treatment of high‐risk localized prostate cancer consists of radical prostatectomy (RP), external beam radiotherapy (EBRT) alone, or EBRT plus brachytherapy boost (EBRT + BT). We utilized the Surveillance, Epidemiology, and End Results (SEER) database to explore the survival outcomes of high‐risk localized prostate cancer by surgery, EBRT alone, or EBRT + BT approaches. The SEER database is an authoritative source of national cancer incidence and survival It collects patient‐level data in 18 cancer registries across the United States and captures 28% of the US population, which represents all American trends. Variables included (a) tumor characteristics, such as T stage, PSA value, Gleason score, and tumor grade; (b) definitive treatment information, such as surgery, EBRT, and EBRT + BT; and (c) patient characteristics, such as age, race, year of diagnosis, geographic locations, and marital status. Cox proportional hazard regression was applied to find associations between baseline covariates including treatment groups and outcomes, which are OS and CSS.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
