AUA 2022: Survival After Radical Prostatectomy Versus Radiation Therapy in Ductal Carcinoma of the Prostate

( The 2022 American Urological Association (AUA) Annual Meeting included a session on surgical therapy of localized prostate cancer and a presentation by Dr. Francesco Chierigo discussing survival after radical prostatectomy versus radiation therapy in ductal carcinoma of the prostate. Given the lack of data comparing these two treatment modalities for this aggressive prostate cancer histology, Dr. Chierigo and colleagues compared cancer specific mortality rates between radical prostatectomy versus external beam radiotherapy among these patients.

Within the Surveillance, Epidemiology, and End Results (SEER) database (2004-2016), there were 369 ductal carcinoma patients identified, of whom 303 (82%) were treated with radical prostatectomy compared to 66 (18%) patients treated with radiotherapy. Kaplan-Meier plots and univariable and stepwise multivariate Cox regression models addressed cancer specific mortality in the unmatched population. After propensity score matching (PSM) and inverse probability of treatment weighting (IPTW), Kaplan-Meier curve and Cox regression models tested the effect of radical prostatectomy versus radiotherapy on cancer specific mortality.

Overall, radiotherapy patients were older, had higher PSA values, higher clinical T, and higher Gleason grade groups. The 5-year cancer specific mortality rates were 4.2% for radical prostatectomy vs 10% for radiotherapy: HR 0.40, 95% CI 0.16-0.99, p=0.048, favoring radical prostatectomy -


At step-by-step multivariate Cox regression, after adjusting for potential confounders, the central tendency of the HR for radical prostatectomy vs radiotherapy approached 1. PSM resulted in 124 patients undergoing radical prostatectomy compared to 53 patients treated with radiotherapy. After PSM, as well as after IPTW, the protective effect of radical prostatectomy was no longer present: HR 1.16, 95% CI 0.23-5.73, p=0.9) -


and HR 0.97, 95% CI 0.35-2.66, p=0.9 -


Dr. Chierigo concluded his presentation by discussing survival after radical prostatectomy versus radiation therapy in ductal carcinoma of the prostate noting that although the cancer specific mortality rate of ductal carcinoma after radical prostatectomy is lower compared to after radiotherapy, this apparent benefit disappears after statistical adjustment for population differences.

Presented by: Francesco Chierigo, Department of Surgical and Diagnostic Integrated Sciences, University of Genova, Genova, Italy

Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, @zklaassen_md on Twitter during the 2022 American Urological Association (AUA) Annual Meeting, New Orleans, LA, Fri, May 13 – Mon, May 16, 2022.

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