Evaluation of Cancer-Specific Mortality with Surgery Versus Radiation as Primary Therapy for Localized High-Grade Prostate Cancer in Men Younger than 60 Years Old

Abstract

PurposeThe optimal primary treatment for localized high-grade prostate cancer in younger men remains controversial. The objective of this project was to compare the impact of initial radical prostatectomy versus radiation therapy on survival outcomes for young men <60 years old with high-grade prostate cancer. Materials and MethodsWe retrospectively analyzed the records of men under 60 years old in the Surveillance, Epidemiology, and End Results (SEER) database who underwent initial surgery or radiation therapy for high-grade (Gleason score ≥ 8) localized (N0M0 TNM stage) prostate cancer from 2004-2012. Univariate and Multivariate Cox proportional hazards regression models were used to examine prostate cancer-specific and overall mortality. ResultsA total of 2,228 men were identified. 1,459 men (65.5%) underwent initial surgery and had a median follow-up of 43 months. 769 men (34.5%) underwent initial external beam radiation therapy ± brachytherapy and had a median follow-up of 44 months. On multivariate analysis, initial treatment with surgery was associated with improvement in prostate cancer-specific mortality and overall mortality compared with initial treatment with radiation (HR 0.37; 95% CI 0.19 – 0.74; p = 0.005 and HR 0.41; 95% CI 0.24 – 0.70; p = 0.001 respectively) when controlling for age, biopsy Gleason score, T stage, and PSA. ConclusionsOur data show significant survival differences in young men treated initially with surgery versus external beam radiation therapy for high-grade prostate cancer. Future prospective randomized trials are needed to confirm long-term outcomes of these treatment approaches.