Localized PCa: front-line surgery tops EBRT for survival in young men

  • Huang H & al.
  • J Urol
  • 1 Jan 2019

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • Young men with high-grade localized prostate cancer who received front-line radical prostatectomy (RP) showed significant improvement in survival vs those who had external beam radiation therapy (EBRT).

Why this matters

  • Guidelines recommend both surgery and radiation therapy as appropriate treatment options for high-grade prostate cancer.
  • Prospective randomized studies are, however, needed to confirm survival benefit of RP over EBRT.

Study design

  • Study of 2228 patients with high-grade (Gleason score 8-10) localized prostate cancer aged
  • Funding: None disclosed.

Key results

  • Median follow-up was 43 months in patients who underwent RP (n=1459) and 44 months in those who received EBRT±brachytherapy (n=769).
  • Patients undergoing RP showed lower estimated 7-year cancer-specific mortality (CSM; 8.2% vs 12.1%; P<.001 and overall mortality vs p>
  • After adjusting for age, biopsy Gleason score, T stage, and PSA, initial RP vs EBRT significantly improved:
    • CSM (HR, 0.37; P=.005) and
    • overall mortality (HR, 0.41; P=.001).

Limitations

  • Retrospective design. 

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