Survival outcomes of radical prostatectomy vs. external beam radiation therapy in prostate cancer patients with Gleason Score 9-10 at biopsy: A population-based analysis.

Gleason Score (GS) 9-10 prostate cancer is associated with particularly adverse oncological outcomes and the optimal treatment is unknown. Therefore, cancer-specific mortality (CSM) rates after radical prostatectomy (RP) ± adjuvant radiation therapy (aRT) vs. external beam radiation therapy (EBRT) were tested.

Within the Surveillance, Epidemiology, and End Results database (2004-2015), 17,897 clinically localized prostate cancer patients with biopsy GS 9-10 were identified who either received RP ± aRT or EBRT. Temporal trends, cumulative incidence plots and multivariable competing-risks regression analyses were used after propensity score matching. Sensitivity analyses were performed according to primary treatment type (RP only vs. EBRT).

Of all, 8,890 (49.7%) underwent EBRT vs. 9,007 (50.3%) underwent RP. Of those, 2,584 (28.7%) received aRT. No significant change in treatment assignment was recorded over time. In cumulative incidence smoothed plots, 10 year CSM rates were 19.9% vs. 19.6% (P = 0.3) and 10 year other-cause mortalityrates were 11.5% vs. 31.2%, respectively, in RP vs. EBRT patients (P < 0.001). In multivariable competing-risks regression analyses, RP did not reach independent predictor status of lower CSM (hazard ratio (HR): 0.93, P = 0.2). In sensitivity analyses within RP only vs. EBRT patients, RP represented an independent predictor of lower CSM (HR: 0.76, P < 0.001).

In biopsy GS 9-10 patients, no CSM differences were observed after RP ± aRT vs. EBRT. However, in patients in whom RP did not have to be combined with aRT, RP seems to be associated with a minor improvement in cancer-specific survival compared to EBRT. This applied to the majority of GS 9-10 RP patients.

Urologic oncology. 2019 Oct 22 [Epub ahead of print]

Sophie Knipper, Carlotta Palumbo, Angela Pecoraro, Giuseppe Rosiello, Zhe Tian, Alberto Briganti, Kevin C Zorn, Fred Saad, Derya Tilki, Markus Graefen, Pierre I Karakiewicz

Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada. Electronic address: ., Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada; Urology Unit, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Italy., Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada; Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy., Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada; Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy., Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada., Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy., Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada; Brunswick Science and Technology, Montreal, Quebec, Canada., Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany., Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.