- In high-risk men with advanced prostate cancer (PCa), radical prostatectomy (RP) with adjuvant radiotherapy (RT) showed significant improvement in cancer-specific survival (CSS) and OS vs RT plus androgen deprivation therapy (ADT).
- Approximately 30% of patients received multimodal treatment.
- Patients receiving RP+RT experienced higher rates of erectile dysfunction and urinary incontinence.
Why this matters
- Study shows many high-risk patients do not receive multimodal treatment recommended by National Comprehensive Cancer Network and European Association of Urology/European Society for Radiotherapy and Oncology guidelines.
- 13,856 high-risk men (age, ≥65 years) with advanced prostate cancer were treated during 1992-2009.
- Funding: None disclosed.
- Median follow-up time, 14.6 years.
- 6.1% of patients received RP+RT, 23.6% received RT+ADT, and 20% received no treatment within 6 months of diagnosis.
- Patients who received RP+RT vs RT+ADT had significant improvement in:
- CSS: T3aN0M0 disease (HR, 4.22; 95% CI, 2.83-6.28), T3bN0M0 disease (HR, 1.84; 95% CI, 1.34-2.53), and T4N0M0 disease (HR, 2.31; 95% CI, 1.05-5.12); and
- OS: T3aN0M0 disease (HR, 1.75; 95% CI, 1.45-2.11), T3bN0M0 disease (HR, 1.49; 95% CI, 1.22-1.84), and T4N0M0 disease (HR, 1.62; 95% CI, 1.00-2.64).
- RP+RT was associated with higher rates of erectile dysfunction (28.3% vs 20.4%; P=.0212) and urinary incontinence (49.1% vs 19.4%; P<.0001>
- Observational design.