Abstract
Simple SummaryScarce reports have evaluated oncologic outcomes in relatively young men with unfavorable intermediate-risk prostate cancer (UIR-PC) receiving radical prostatectomy (RP) or high-dose intensity-modulated radiotherapy (IMRT). After a literature review, we present the leading and largest head-to-head propensity score-matched study to examine all-cause death, biochemical failure (BF), locoregional recurrence (LRR), and distant metastasis (DM) in relatively young men with UIR-PC undergoing RP or high-dose IMRT. After adjustment for confounders, RP was found to be superior to high-dose IMRT in terms of the patients’ overall survival, BF, LRR, and DM.Purpose: To estimate the oncologic outcomes of radical prostatectomy (RP) and high-dose intensity-modulated radiotherapy (IMRT) with short-term androgen-deprivation therapy (ADT) in relatively young men with unfavorable intermediate-risk prostate cancer, as defined by the National Comprehensive Cancer Network (NCCN-UIR-PC). Patients and Methods: We enrolled relatively young men (≤65 years) from the Taiwan Cancer Registry who had been diagnosed as having NCCN-UIR-PC and who had received RP or high-dose IMRT (at least ≥72 Gy) with short-term ADT (4–6 months). After propensity score matching of the confounders, Cox proportional regression was used to model the time from the index date (i.e., date of diagnosis) to all-cause death, biochemical failure (BF), locoregional recurrence (LRR), and distant metastasis (DM). Results: The corresponding adjusted hazard ratios (95% confidence intervals) of the risk of all-cause death, BF, LRR, and DM were 2.76 (1.36–5.60, p = 0.0050), 2.74 (1.72–4.84, p < 0.0001), 1.28 (1.09–1.90, p = 0.0324), and 2.11 (1.40–4.88, p = 0.0052), respectively. Conclusions: RP is superior to high-dose IMRT with short-term ADT in terms of oncologic outcomes for relatively young men with UIR-PC.
Highlights
An estimated 1,300,000 new cases of prostate cancer (PC) are reported annually worldwide, making it the second most common cancer diagnosis in men [1]
radical prostatectomy (RP) was associated with a higher OS than definitive high-dose intensity-modulated radiotherapy (IMRT) combined with short-term androgen-deprivation therapy (ADT) in Relatively young patients with NCCNUIR-PC after multivariable Cox regression analysis
The adjusted HR (aHR) of biochemical failure (BF) for IMRT compared with RP was 2.74 (1.72–4.84, p < 0.0001) (Table 3)
Summary
An estimated 1,300,000 new cases of prostate cancer (PC) are reported annually worldwide, making it the second most common cancer diagnosis in men [1]. The Surveillance, Epidemiology, and End Results program indicated that between 2010 and 2015, the incidence of low-risk PC decreased while that of intermediate-risk, high-risk, and very high–risk PC increased in relatively young men in the United States [2]. Based on the National Comprehensive Cancer Network (NCCN) risk classification, intermediate-risk PC is the most common PC diagnosis worldwide as well as in Taiwan [1,2,3], and the oncologic outcomes of different treatments for men with intermediate-risk PC, especially those with a longer life expectancy, are valuable for decision-making by clinicians and patients
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