Abstract
BackgroundOptimal treatment of high-risk prostate cancer remains controversial. We aimed to compare treatment outcomes of prostate cancer patients treated with definitive external-beam radiotherapy (ExRT) or radical prostatectomy (RP).MethodsThe records of 120 high-risk clinical stage T2b-T4 N0 M0 prostate cancer patients treated with definitive ExRT or RP were reviewed. Patients with pretreatment prostate-specific antigen (PSA) levels ≥20 ng/mL or clinical ≥T3 stage or Gleason score (GS) ≥8 were included in the study. Biochemical failure free survival (BFFS), distant metastasis free survival (DMFS), cancer-specific survival (CSS) and overall survival (OS) were analyzed. Cox regression analysis was performed to determine predictors of BF.ResultsSeventy-two patients received definitive ExRT with androgen-deprivation therapy in 95.8% and 48 patients underwent RP with pelvic lymph node dissection. Mean age (67.7 ± 6.6 vs 64.5 ± 7.6 year, p = 0.017) and the rate of patients with PSA levels ≥20 ng/mL (69.4% vs 47.9%, p = 0.022) were higher in the definitive ExRT group than the RP group. Distributions of GS and clinical T stage were similar. Mean follow-up was 60.2 ± 30.3 months in the definitive ExRT group and 41.3 ± 21.5 months in the RP group (p < 0.001). Twenty-five % of the RP group received adjuvant ExRT and 41.7% received salvage ExRT. Biochemical failure was significantly higher (52.1% vs 21.4%, p < 0.001) and the mean BFFS was significantly lesser (34.4 ± 3.9 vs 97.8 ± 5.9 months, p < 0.001) in the RP group than the definitive ExRT group. However, DMFS, CSS and OS were similar in both groups. In multivariate analysis, being in the RP group significantly increased the risk of BF (p < 0.001). Furthermore, not receiving pelvic lymphatic irradiation in the definitive ExRT group (p = 0.048) and having positive surgical margin in the RP group (p = 0.050) increased the risk of BF.ConclusionsBF was significantly higher and the mean BFFS was significantly lesser in high-risk prostate cancer patients undergoing RP than definitive ExRT while DMFS, CSS and OS were similar in both treatment groups.
Highlights
Optimal treatment of high-risk prostate cancer remains controversial
Distant metastasis, cancer-specific mortality, all-cause mortality, distant metastasis free survival (DMFS), cancer-specific survival (CSS) and overall survival (OS) were similar in both groups
When all patients were included, univariate analysis showed that being in the treatment group radical prostatectomy (RP) was the only significant (p < 0.001) predictor of biochemical failure (BF) while age was borderline significant (p = 0.066) and multivariate analysis showed that being in the treatment group RP was still the only significant (p < 0.001) predictor of BF and pretreatment prostate-specific antigen (PSA) level ≥ 20 ng/mL was borderline significant (p = 0.069)
Summary
We aimed to compare treatment outcomes of prostate cancer patients treated with definitive external-beam radiotherapy (ExRT) or radical prostatectomy (RP). The current definitions of high-risk PCa include a heterogeneous group of patients with a range of prognoses and the optimal management of the subgroups is under debate [3,4,5,6,7]. High-risk PCa patients are treated with a combination of definitive external-beam radiotherapy (ExRT) and androgen-deprivation therapy (ADT) [8,9,10]. Recent published data suggests that radical prostatectomy (RP) shows excellent local tumor control and similar oncological results in high-risk PCa patients, especially in combination with multimodal treatments involving ADT and radiotherapy [11,12,13,14]. The American Urological Association (AUA) and European Association of Urology (EAU) support RP with extended pelvic lymph node dissection (PLND) as an optional treatment for a selective group of patients in the context of multimodal treatment [3, 4]
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