AUA 2018: Oncologic Outcomes in Men with High Risk Prostate Cancer Eligible for Both Radical Prostatectomy and Radiotherapy: MD Anderson Multidisciplinary Clinic Experience

San Francisco, CA ( The optimal local therapy for patients with high risk prostate cancer remains an issue of considerable debate. Both radical prostatectomy and radiotherapy with concomitant androgen deprivation therapy are reasonable choices. In a moderated poster at the American Urologic Association Annual Meeting, Dr Reichard and colleagues present a comparative analysis of these two modalities based on the experience at the MD Anderson Cancer Center Multidisciplinary Clinic. 

The authors examined patients with high risk prostate cancer who presented to the multidisciplinary clinic between 2004-2013. They identified those patients who were eligible for both a surgical approach (radical prostatectomy with pelvic lymph node dissection) and a radiotherapy approach (external beam radiotherapy with androgen deprivation). They examined oncologic outcomes including biochemical recurrence, distant metastasis, and overall survival. They defined biochemical recurrence as a PSA >=0.2 ng/mL with subsequent confirmation among patients who underwent RP and nadir + 2 ng/mL in patients who underwent radiotherapy. 

Interestingly, of men eligible for either treatment approach, 231 (76%) opted for surgery while 74 (24%) opted for radiotherapy. The median age was 63 years and 28% of eligible patients had very high risk disease, characterised by multiple high risk features, >4 biopsy cores of Gleason 8 disease, or primary pattern Gleason 5). While patients who opted for radiotherapy were older (median 66 years vs 62 years), overall Charlson Co-morbidity, clinical T stage, PSA, biopsy grade and ethnicity were similar between the two groups. Patients in the radiotherapy arm received ADT for a median of 22 months (range 5-26 months). 

Over a median follow-up of 61 months, 5-year biochemical failure rates were higher for men treated with radiotherapy. However, there were no significant differences in rates of distant metastases or in overall survival. Following Cox proportional hazard modelling, surgery (compared to radiotherapy) and African American race (compared with Caucasian) were associated with an increased risk of biochemical recurrence. 

Given the known problems with comparing biochemical recurrence between treatment modalities, these data should be interpreted to show no significant difference in outcomes of the treatment of high risk and very high risk prostate cancer among patients eligible for each.

Presented By: Chad A. Reichard 
Co-authors: Karen Hoffman, Pamella K. Allen, Stephen B. Williams, Mary F. Achim, Deborah A. Kuban, Brian F. Chapin 

Written by: Christopher J.D. Wallis, Urology Resident, University of Toronto, Twitter: @WallisCJDat the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA