To test for cancer specific mortality (CSM) differences after either radical prostatectomy (RP) or radiotherapy (RT) in incidental prostate cancer (IPCa) patients.
Within the Surveillance, Epidemiology, and End Results (SEER) database (2004-2015), IPCa patients were identified. Cumulative incidence plots as well as competing risks regression (CRR) models were fitted to address CSM after adjustment for other-cause mortality (OCM). Furthermore, a subgroup analysis was performed to test for CSM differences between RP and RT according to Gleason sum (GS 6,7, and 8-10).
Of 1,466 IPCa patients, 770 (53%) underwent RP vs. 696 (47%) RT. Incidental PCa RT patients were older, and exhibited higher PSA, higher proportion of Gleason sum 8-10, and higher clinical T stage. In cumulative incidence plots, 5-year CSM rates adjusted for OCM were 0.9 for RP vs. 6.8% for RT (Δ = 5.9%). After multivariable adjustment for clinical characteristics (age, PSA, Gleason sum, and clinical T stage) as well as for OCM, RP was associated with a protective hazard ratio (HR) of 0.35 (95% confidence interval [CI] 0.15 - 0.78, p value = .01). Within Gleason sum 8-10 IPCA patients, RP was associated with a protective HR of 0.31 (P = .039).
Incidental PCa RT-treated patients exhibited less favorable clinical characteristics than their RP counterparts. Despite full adjustment, RP was associated with a protective effect relative to RT. This effect exclusively applied to the Gleason sum 8-10 subgroup. In consequence, IPCa patients harboring Gleason sum 8-10 should ideally be considered for RP instead of RT.
Urologic oncology. 2025 Jan 17 [Epub ahead of print]
Francesco Di Bello, Lukas Scheipner, Andrea Baudo, Mario de Angelis, Letizia Maria Ippolita Jannello, Carolin Siech, Zhe Tian, Kira Vitucci, Jordan A Goyal, Claudia Collà Ruvolo, Gianluigi Califano, Massimiliano Creta, Simone Morra, Pietro Acquati, Fred Saad, Shahrokh F Shariat, Luca Carmignani, Ottavio de Cobelli, Sascha Ahyai, Alberto Briganti, Felix K H Chun, Nicola Longo, Pierre I Karakiewicz
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy. Electronic address: ., Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, Medical University of Graz, Graz, Austria., Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, IRCCS Policlinico San Donato, Milan, Italy., Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy., Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Università degli Studi di Milano, Milan, Italy., Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Goethe University Frankfurt, University Hospital, Department of Urology, Frankfurt am Main, Germany., Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada., Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy., Department of Urology, IRCCS Policlinico San Donato, Milan, Italy., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York, New York, USA; Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA; Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan., Department of Urology, IRCCS Policlinico San Donato, Milan, Italy; Department of Urology, IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy., Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy., Department of Urology, Medical University of Graz, Graz, Austria., Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy., Goethe University Frankfurt, University Hospital, Department of Urology, Frankfurt am Main, Germany.