Abstract
PurposeThe efficacy of local treatments (LTs) in selected patients with metastatic prostate cancer (mPCa) had been demonstrated. However, the comparative effectiveness between LTs is unclear. Here, we compared the impact of radical prostatectomy (RP) and brachytherapy (RT) on the survival outcomes of mPCa patients.Materials and MethodsmPCa patients who received RT or RP between 2004 and 2016 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Multivariable Cox proportional hazards analysis was used to evaluate the comparative risk of prostate cancer-specific mortality (CSM) and all-cause mortality (ACM) between LTs. A 1:1 propensity score matching (PSM) and adjusted standardized mortality ratio weighting (SMRW) were performed to balance the clinicopathological characteristics of the groups.ResultsOf 684 mPCa patients, 481 underwent RP and 203 received RT. After PSM, both groups included 148 cases, and RT resulted in comparable CSM versus RP [CSM: hazard ratio (HR) = 0.77, p = 0.325; ACM: HR = 0.73, p = 0.138], which was consistent with the SMRW model [CSM: HR = 0.83, p = 0.138; overall survival (OS): HR = 0.75, p = 0.132]. However, RP was associated with a lower CSM in the T1–2 subgroup (HR = 0.42, p = 0.048) and a lower ACM in the T1–2 (HR = 0.55, p = 0.031) and prostate-specific antigen (PSA) ≤20ng/ml (HR = 0.48, p = 0.022) subgroups. Besides, the results showed that the mortality risk was similar between the two groups in the T3–4, Gleason score (GS) >7, PSA >20 ng/ml, and all metastatic subgroups (all p > 0.100).ConclusionsRP could confer better survival outcomes than could RT in mPCa patients with favorable primary tumor features, but not in those with advanced primary tumor features. Moreover, the metastatic substage has limited impact on the comparative effectiveness between RP and RT. Further clinical trials are necessary to confirm the present results.
Highlights
The landscape of the management of metastatic prostate cancer is changing rapidly with the new generation of hormone therapies and other treatment options emerging and changing the paradigms that have persisted for decades [1]
The two groups were well balanced after Propensity score matching (PSM), given that no significant differences were observed for all key variables
radical prostatectomy (RP) was associated with a lower cancer-specific mortality (CSM) in the T1–2 subgroup (HR = 0.42, 95% confidence intervals (95%CIs) = 0.17–0.99, p = 0.048)
Summary
The landscape of the management of metastatic prostate cancer (mPCa) is changing rapidly with the new generation of hormone therapies and other treatment options emerging and changing the paradigms that have persisted for decades [1]. In this context, there is growing interest in whether local treatments (LTs) for the primary lesion could improve the survival outcomes of mPCa patients. The proliferation of metastasis at distant sites is stimulated and maintained by compounds secreted by primary cancer into circulation [3] Based on these concepts, LTs of the primary tumor could improve survival through inhibiting not just the initiation of distant disease and the progression of the existing metastases. We compared the impacts of RP and RT on the survival outcomes after adjustment for other clinicopathological characteristics in the most contemporary population-based cohort of mPCa patients
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