Abstract
Background/objectiveThere are no randomized trials on the comparative effectiveness of radical prostatectomy (RP) and radiotherapy (RT) for high-risk prostate cancer. Our aim was to compare treatment outcomes of high-risk prostate cancer after RP and RT, including overall survival (OS), biochemical-progression-free survival (bPFS) and disease-progression-free survival (dPFS), using two cancer treatments centers’ patient data.MethodsData on high-risk prostate cancer patients between 2005 and 2009 were retrospectively reviewed in two cancer centers: National Cancer Institute, Vilnius, Lithuania and N.N. Alexandrov National Cancer Centre of Belarus, Minsk, Belarus; 210 patients were included in the study group treated with RP (n = 174) or RT (n = 36). The mean follow-up time was 5.6 and 6.6 years, respectively.ResultsLower T stage was an independent predictor of better OS (p = 0.01) and bPFS (p = 0.03). Only the highest Gleason score ≥8 was significantly predictive of a worse OS (p = 0.05), bPFS (p = 0.02) and dPFS (p = 0.001). A high PSA level was predictive of a worse bPFS (p = 0.007 for PSA ≥20) and dPFS (p = 0.008 for ≥20). The treatment modality in this study was insignificant after T stage, Gleason score and PSA level adjustment for OS, bPFS survival and dPFS survival (p = 0.17, p = 0.39, p = 0.20).ConclusionsThe T stage, Gleason score and pretreatment PSA level are significant factors for OS, bPFS survival, and dPFS survival of highrisk prostate cancer patients. Treatment option (RP or RT) was not an independent predictor of survival in this study.
Highlights
Prostate cancer is the most common cancer in men worldwide [1] and the second cause of cancer-related death in men in the Western world [2]
High-risk prostate cancer patients were treated according to the standard hospital treatment protocol which corresponds to the Lithuanian Urologist Association recommendations based on the protocol confirmed by the Lithuanian Ministry of Health (2002-08-14, 422)
There were no notable imbalances with regard to the mean age, the biopsy Gleason score and the mean pretreatment PSA level
Summary
Prostate cancer is the most common cancer in men worldwide [1] and the second cause of cancer-related death in men in the Western world [2]. The main treatment options for high-risk prostate cancer are radical prostatectomy (RP) and radiotherapy (RT). There is no consensus on which is superior [3], as no decisive large prospective randomised clinical trial comparing the outcomes of the treatments has been done yet. The only data sources currently available are retrospective studies. They are quite numerous, their results are controversial as well – most of them favor RP [7], but some favor RT [8,9,10]
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