High-risk PCa: surgery, radiation regimens offer similar outcomes

  • Tilki D & et al.
  • JAMA Oncol
  • 15 Nov 2018

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • In patients with high-risk (Gleason score 9-10) prostate cancer, radical prostatectomy (RP) with adjuvant external beam radiotherapy (EBRT) and androgen deprivation therapy (ADT) is likely to produce survival outcomes equivalent to EBRT+brachytherapy+ADT (MaxRT).

Why this matters

  • In high-risk patients undergoing RP, adjuvant EBRT and ADT may reduce mortality risk to that of MaxRT.

Study design

  • Study of 639 men with clinical T1-4,N0M0 biopsy Gleason score 9-10 prostate cancer.
  • Funding: None disclosed.

Key results

  • 80 patients received MaxRT (median follow-up, 5.51 years).
  • 559 patients received RP (median follow-up, 4.78 years): RP, 372; RP+adjuvant RT, 88; RP+adjuvant RT+ADT (MaxRP), 50; RP+adjuvant ADT, 49.
  • There was no significant difference in the risk for cancer-specific mortality (CSM; aHR, 1.33; P=.58) and all-cause mortality (ACM; aHR, 0.80; P=.60) in men who underwent MaxRP vs MaxRT.
  • Compared with MaxRT, the risk for mortality was higher with
    • RP (aHRPCSM, 2.80; P=.01), and
    • RP+adjuvant ADT (aHRPCSM, 3.15; aHRACM, 2.33; both P=.01).
  • Compared with MaxRT, plausibility index of equivalence of the risk for prostate cancer-specific mortality (PCSM) and ACM was highest after MaxRP (76.75% and 77.97%, respectively).
    • For other RP containing treatments, it was 4.62%-62.32%.

Limitations

  • Observational data.

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