Surgery vs radiotherapy for high-grade prostate cancer with low PSA

  • Guo Y & al.
  • Front Oncol
  • 1 Jan 2019

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • In patients with high-grade prostate cancer and low PSA levels, radical prostatectomy (RP) improves OS vs external beam radiotherapy (EBRT)±brachytherapy (BT).
  • Cancer-specific mortality (CSM) with RP was similar to EBRT+BT but significantly lower vs EBRT.

Why this matters

  • No standard treatment exists for these patients.
  • EBRT+BT can be an alternative option in patients aged >70 years or with PSA ≤2.5 ng/mL.

Study design

  • 9114 patients with prostate cancer with PSA ≤10 ng/mL and Gleason score 8-10 received RP (n=4175), EBRT (n=4114), or EBRT+BT (n=825).
  • Funding: National Natural Science Foundation of China.

Key results

  • Median follow-up duration, 47 months.
  • Compared with RP:
    • OS was worse with EBRT (aHR, 3.36; P<.001 p=".002).</li">
    • CSM risk was higher with EBRT (aHR, 2.46; P=.001).
    • Risk for CSM was not significantly different with EBRT+BT (aHR, 1.31; P=.485).
  • OS and CSM were similar with RP and EBRT+BT in:
    • patients aged >70 years: aHR, 1.84 (P=.071) and 1.63 (P=.266), respectively; or
    • patients with PSA levels ≤2.5 ng/mL: aHR, 0.58 (P=.556) and 1.27 (P=.774), respectively.
  • EBRT was associated with worse OS in patients aged >70 years (aHR, 3.07; P<.001 and with psa ng p=".008)" vs rp.>

Limitations

  • Retrospective study.