Oncologic Outcomes of Radical Prostatectomy and High-Dose Intensity-Modulated Radiotherapy with Androgen-Deprivation Therapy for Relatively Young Patients with Unfavorable Intermediate-Risk Prostate Adenocarcinoma

Abstract

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.

Comparison of Clinical Outcomes of Radical Prostatectomy versus IMRT with Long-Term Hormone Therapy for Relatively Young Patients with High- to Very High-Risk Localized Prostate Cancer

“…The current manuscript includes totally different populations and outcomes from our previous study [ 2 ]. The population, cT stages, PSA, Gleason scores grade, treatments, ADT use, surgical difficulties and complications, life expectancy, and numbers of unfavorable intermediate-risk groups are very different from high- to very high-risk groups.…”

“…To verify the cause of death and vital status of each patient, The TCRD death registry was additionally linked to the NHIRD. The detailed data on LPC, such as the American Joint Committee on Cancer (AJCC) stage, surgical procedures, techniques, RT dose, hormone treatments, and pathologic stages, were included in TCRD [ 2 , 20 , 21 , 22 , 23 ].…”

“…Our protocols were reviewed and approved by the Institutional Review Board (IRB109-015-B). The specific method is stated in our previous paper [ 2 ].…”

“…According to estimates from Global Cancer Statistics 2020, prostate cancer (PC) is the second most common cancer (1,414,259 new cases) and the fifth leading cause of cancer-related deaths (375,304 deaths) in men worldwide [ 1 ]. According to the Taiwan Cancer Registry database (TCRD), PC is the fifth most common cancer and the sixth leading cause of cancer-related deaths in men in Taiwan [ 2 , 3 ]. Increased treatment efficacy and decreased treatment-related side effects are the most critical concerns for patients with PC [ 4 ], especially younger patients whose survival is expected to be relatively long.…”

Diagnosis and Treatment of Prostate Adenocarcinoma

“…Wu et al [5] compared the oncologic outcomes of radical prostatectomy to those of intensity-modulated radiation therapy and androgen deprivation therapy in relatively young patients with intermediate prostate cancer. They found that radical prostatectomy was better than intensity-modulated radiation therapy plus androgen deprivation therapy in terms of oncologic outcomes in these patients.…”