Survival Significance of Patients With Low Prostate-Specific Antigen and High-Grade Prostate Cancer After Radical Prostatectomy, External Beam Radiotherapy, or External Beam Radiotherapy With Brachytherapy.

Yadong Guo,Junfeng Zhang,Longsheng Wang,Aihong Zhang,Xuan Cao,Bin Yang,Shiyu Mao,Xudong Yao,Ruiliang Wang,Yuan Wu,Ziwei Zhang,Wentao Zhang

doi:10.3389/fonc.2019.00638

Yadong Guo, Junfeng Zhang + Show 10 more

Open Access

https://doi.org/10.3389/fonc.2019.00638

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Abstract

Objective: This study compared survival of prostate cancer patients with low prostate specific antigen level (PSA ≤ 10 ng/ml) and high-grades of Gleason score (GS) of 8–10 with different treatment options (i.e., radical prostatectomy [RP], external beam radiotherapy [EBRT], or external beam radiotherapy with brachytherapy [EBRT+BT]).Materials and Methods: The Surveillance, Epidemiology and End Results (SEER) database data (2004–2013), and overall survival (OS) and prostate cancer-specific mortality (PCSM), were evaluated using the Cox proportional hazards regression model and Fine and Gray competing risk model.Results: The SEER data contained 9,114 patients, 4,175 of whom received RP, 4,114 received EBRT, and 825 received EBRT+BT with a median follow-up duration of 47 months. RP patients had significantly better OS than patients with EBRT and EBRT+BT (adjusted HR [AHR]: 3.36, 95% CI: 2.43–4.64, P < 0.001; AHR: 2.15, 95% CI: 1.32–3.48, P = 0.002; respectively). There was no statistical difference in PCSM between RP and EBRT+BT (AHR: 1.31, 95% CI: 0.61–2.80, P = 0.485), while EBRT had worse OS (P < 0.05). The subgroup analysis revealed that there was no statistical difference in prognosis of patients with age of >70 years old, or PSA levels of ≤ 2.5 ng/ml between RP and EBRT+BT (P > 0.05).Conclusion: RP patients with low PSA levels and high GS had better OS compared to either EBRT or EBRT+BT, while RP and EBRT+BT resulted in significantly lower PCSM, compared to EBRT. Moreover, EBRT+BT and RP were associated with similar survival of patients with age of > 70 years old, or PSA levels of ≤ 2.5 ng/ml.

Highlights

In the USA, prostate cancer has an estimated of 164,690 new cases and 29,430 cancer-related deaths in 2018 [1]
The multivariate Cox regression analysis after adjusting for the patient’s marital status, age at diagnosis, race, PSA level, clinical T stage, and GS revealed that radical prostatectomy (RP) was associated with better OS, compared to external beam radiation therapy (EBRT) or EBRT+BT
RP was associated with significantly better prostate cancer-specific mortality (PCSM), compared to EBRT (AHR: 2.46, 95% CI: 1.45–4.18, P = 0.001; Table 3)

Summary

Introduction

In the USA, prostate cancer has an estimated of 164,690 new cases and 29,430 cancer-related deaths in 2018 [1]. Other retrospective studies have revealed better survival of patients after EBRT + BT [5]. Studies have reported that RP could improve cancer-specific mortality in patients with highrisk prostate cancer [6]. Another retrospective study revealed that there was no statistically significant difference in survival between patients receiving RP and EBRT + BT with or without androgen deprivation therapy (ADT) in highrisk localized prostate cancer patients after adjusting for the prognostic factors of prostate cancer [7]. Patients with high-grade and low PSA level had poorer prognosis [10]. The present study selected these patients from the Surveillance, Epidemiology, and End Results (SEER) database, and assessed their survival significance after treatment with RP and RT (EBRT or EBRT + BT)

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Discussion

Conclusion