Abstract
PurposeTo test the association between external beam radiotherapy (EBRT) after radical prostatectomy (RP) vs RP only on rates of other-cause mortality (OCM) in men with prostate cancer (PCa).Patients and methodsWithin the 2004–2016 Surveillance, Epidemiology, and End Results database, we identified 181,849 localized PCa patients, of whom 168,041 received RP only vs 13,808 who received RP + EBRT. Cumulative incidence plots displayed OCM between RP vs RP + EBRT after propensity score matching for age, PSA, clinical T- and N-stages, and biopsy Gleason scores. Multivariable competing risks regression models addressed OCM, accounting prostate cancer-specific mortality (CSM) as a competing event. Stratifications were made according to low- vs intermediate- vs high-risk groups and additionally according to age groups of ≤ 60, 61–70, and ≥ 71 years, within each risk group.ResultsIn low-, intermediate-, and high-risk patients, RP + EBRT rates were 2.7, 5.4 and 17.0%, respectively. After matching, 10-year OCM rates between RP and RP + EBRT were 7.7 vs 16.2% in low-, 9.4 vs 13.6% in intermediate-, and 11.4 vs 13.5% in high-risk patients (all p < 0.001), which, respectively, resulted in multivariable HR of 2.1, 1.3, and 1.2 (all p < 0.001). In subgroup analyses, excess OCM was recorded in low-risk RP + EBRT patients of all age groups (all p ≤ 0.03), but only in the older age group in intermediate-risk patients (61–70 years, p = 0.03) and finally, only in the oldest age group in high-risk patients (≥ 71 years, p = 0.02).ConclusionExcess OCM was recorded in patients exposed to RT after RP. Its extent was most pronounced in low-risk patients, decreased in intermediate-risk patients, and was lowest in high-risk patients.
Highlights
Adjuvant or salvage external beam radiotherapy therapy (EBRT) after radical prostatectomy (RP) for prostate cancer (PCa), with or without concomitant androgen deprivation therapy (ADT), is regarded as a valuable treatment option in highly select patients with adverse pathology at RP, such as positive surgical margins, Gleason score 8–10, ≥ pT3, or pN1 stage [1–5], and is recommended by the European Association of Urology, as well as by the National Comprehensive Cancer Network [6, 7]
propensity score matching (PSM) focused on 1,121 RP + EBRT patients, who were matched with four RP controls (n = 4,326)
In multivariable competing risks regression models (CRR) analyses (Table 2), RP + EBRT was an independent predictor of higher other-cause mortality (OCM) compared to RP (HR 2.1, 95% confidence intervals (95% CI) 1.7–2.6, p < 0.001)
Summary
Adjuvant or salvage external beam radiotherapy therapy (EBRT) after radical prostatectomy (RP) for prostate cancer (PCa), with or without concomitant androgen deprivation therapy (ADT), is regarded as a valuable treatment option in highly select patients with adverse pathology at RP, such as positive surgical margins, Gleason score 8–10, ≥ pT3, or pN1 stage [1–5], and is recommended by the European Association of Urology, as well as by the National Comprehensive Cancer Network [6, 7]. Some of long-term metabolic toxicities associated with EBRT and/or ADT may result in decreased life expectancy, due to mortality from non-PCa-related causes [8–14]. To address this void, we tested other-cause mortality (OCM) in patients who received RP only vs RP + EBRT. We hypothesized that no OCM difference distinguish RP vs RP + EBRT, regardless of PCa risk group or age [9, 15]
Sign-in/Register to view highlights & summary 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.
