High-risk PCa: prostatectomy plus radiotherapy improves survival

  • Jang TL & al.
  • Cancer
  • 25 Sep 2018

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • 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.

Study design

  • 13,856 high-risk men (age, ≥65 years) with advanced prostate cancer were treated during 1992-2009.
  • Funding: None disclosed.

Key results

  • 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>

Limitations

  • Observational design.

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