Long‐term survival after radical prostatectomy versus external‐beam radiotherapy for patients with high‐risk prostate cancer

Abstract

BACKGROUND:The long-term survival of patients with high-risk prostate cancer was compared after radical prostatectomy (RRP) and after external beam radiation therapy (EBRT) with or without adjuvant androgen-deprivation therapy (ADT). METHODS: In total, 1238 patients underwent RRP, and 609 patients received with EBRT (344 received EBRT plus ADT, and 265 received EBRT alone) between 1988 and 2004 who had a pretreatment prostate-specific antigen (PSA) level 20 ng/mL, a biopsy Gleason score between 8 and 10, or clinical tumor classification T3. The median follow-up was 10.2 years, 6.0 years, and 7.2 years after RRP, EBRT plus ADT, and EBRT alone, respectively. The impact of treatment modality on systemic progression, cancer-specific survival, and overall survival was evaluated using multivariate Cox proportional hazard regression analysis and a competing risk-regression model. RESULTS:The 10-year cancer-specific survival rate was 92%, 92%, and 88% after RRP, EBRT plus ADT, and EBRT alone, respectively (P ¼ .06). After adjustment for case mix, no significant differences in the risks of systemic progression (hazard ratio [HR], 0.78; 95% confidence interval [CI], 0.51-1.18; P ¼ .23) or prostate cancer death (HR, 1.14; 95% CI, 0.68-1.91; P ¼ .61) were observed between patients who received EBRT plus ADT and patients who underwent RRP. The risk of all-cause mortality, however, was greater after EBRT plus ADT than after RRP (HR, 1.60; 95% CI, 1.25-2.05; P ¼ .0002). CONCLUSIONS: RRP alone and EBRT plus ADT provided similar long-term cancer control for patients with high-risk prostate cancer. The authors concluded that continued investigation into the differing impact of treatments on quality-of-life and noncancer mortality will be necessary to determine the optimal management approach for these patients. Cancer 2011;117:2883-

An audit of referral and treatment patterns of high-risk prostate cancer patients in Alberta

“…[4][5][6][7] On the other hand, large retrospective studies with long followup times demonstrated equivalence of RP to RT + ADT. [8][9][10][21][22][23][24][25][26] A meta-analysis showed a modest improvement in cancer-specific survival with RP compared to RT + ADT. 21 However, this finding was based on two small retrospective studies and the authors of the meta-analysis were concerned about the limited quality of most studies included in the meta-analysis.…”

“…22,23 In contrast, Boorjian et al reported similar 10-year cancer-specific survival in patients treated with RP or RT + ADT. 8 Overall, the retrospective data that compared outcomes of RP to RT + ADT suffered from selection bias, variable length of ADT use, and contamination of the RP cohort by adjuvant and salvage therapies.…”

“…[4][5][6][7] However, several retrospective studies suggested that radical prostatectomy (RP) may provide comparable outcomes to RT + ADT, but no RCT has compared them directly. [8][9][10] Therefore, the optimal treatment approach to HR-PCa remains controversial. Urologists are usually the first specialists to see these patients and may or may not elect to refer patients for a discussion of RT + ADT.…”

Radical Prostatectomy Versus Radiation and Androgen Deprivation Therapy for Clinically Localized Prostate Cancer: How Good Is the Evidence?

“…One was a randomized controlled clinical trial, and the remaining were observational studies. Based on the GRADE system, 93% (13 observational of 14) of the studies were considered to have a low level of confidence in quality (4,(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). Table 2 lists the 14 studies in chronologic order, the RS assigned to each, and the scoring of each individual component.…”

Management of high-risk prostate cancer: surgery or radiotherapy with hormonal treatment

“…En l'absence de séries comparatives et randomisées, les résultats de la PT avec ou sans traitement adjuvant apparaissent superposables, dans une population sélectionnée de patients, à l'association radiothéra-pie-hormonothérapie en termes de survie sans récidive biologique et de survie spécifique et globale [4,6,13,14,34]. La morbidité de la PT dans les tumeurs à haut risque semble comparable à celle de la PT pour les tumeurs localisées, lorsqu'elle est réalisée par un chirurgien expérimenté [4,6,14,30,34].…”