Surgery Vs Radiotherapy in the Management of Biopsy Gleason Score 9-10 Prostate Cancer and the Risk of Mortality

Overview

Journal JAMA Oncol

Publisher American Medical Association

Specialty Oncology

Date 2018 Nov 20

PMID 30452521

Citations 31

Authors

Derya Tilki

Ming-Hui Chen

Jing Wu

Hartwig Huland

Markus Graefen

Michelle Braccioforte

Brian J Moran

Anthony V DAmico

Affiliations

Soon will be listed here.

Abstract

Importance: It is unknown how treatment with radical prostatectomy (RP) and adjuvant external beam radiotherapy (EBRT), androgen deprivation therapy (ADT), or both (termed MaxRP) compares with treatment with EBRT, brachytherapy, and ADT (termed MaxRT).

Objective: To investigate whether treatment of Gleason score 9-10 prostate cancer with MaxRP vs MaxRT was associated with prostate cancer-specific mortality (PCSM) and all-cause mortality (ACM) risk.

Design, Setting, And Participants: The study cohort comprised 639 men with clinical T1-4,N0M0 biopsy Gleason score 9-10 prostate cancer. Between February 6, 1992, and April 26, 2013, a total of 80 men were consecutively treated with MaxRT at the Chicago Prostate Cancer Center, and 559 men were consecutively treated with RP and pelvic lymph node dissection at the Martini-Klinik Prostate Cancer Center. Follow-up started on the day of prostate EBRT or RP and concluded on October 27, 2017.

Exposures: Of the 559 men managed with RP and pelvic lymph node dissection, 88 (15.7%) received adjuvant EBRT, 49 (8.8%) received ADT, and 50 (8.9%) received both.

Main Outcomes And Measures: Treatment propensity score-adjusted risk of PCSM and ACM and the likelihood of equivalence of these risks between treatments using a plausibility index.

Results: The cohort included 639 men, with a mean (SD) age of 65.83 (6.52) years. After median follow-ups of 5.51 years (interquartile range, 2.19-6.95 years) among 80 men treated with MaxRT and 4.78 years (interquartile range, 4.01-6.05 years) among 559 men treated with RP-containing treatments, 161 men had died, 106 (65.8%) from prostate cancer. There was no significant difference in the risk of PCSM (adjusted hazard ratio, 1.33; 95% CI, 0.49-3.64; P = .58) and ACM (adjusted hazard ratio, 0.80; 95% CI, 0.36-1.81; P = .60) when comparing men who underwent MaxRP vs MaxRT, with plausibility indexes for equivalence of 76.75% for the end point of the risk of PCSM and 77.97% for the end point of the risk of ACM. Plausibility indexes for all other treatment comparisons were less than 63%.

Conclusions And Relevance: Results of this study suggest that it is plausible that treatment with MaxRP or MaxRT for men with biopsy Gleason score 9-10 prostate cancer can lead to equivalent risk of PCSM and ACM.

Citing Articles

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Utilization of Radical Prostatectomy Versus Radiation Therapy for Gleason Grade Group 5 Prostate Cancer Before and After USPSTF Grade D Recommendation Against Prostate-Specific Antigen Screening in 2012.

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Favorable prostate-specific antigen levels correlate with a worse prognosis in high-grade prostate cancer: a population-based analysis.

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Assessing the Efficacy and Long-Term Outcomes of Surgical Intervention Versus Radiotherapy: A Comprehensive Systematic Review and Meta-Analysis of Prostate Cancer Treatment Modalities.

Waraich T, Khalid S, Kathia U, Ali A, Qamar S, Yousuf A Cureus. 2024; 16(4):e58842.

PMID: 38784314 PMC: 11115355. DOI: 10.7759/cureus.58842.

Radical prostatectomy versus external beam radiotherapy with androgen deprivation therapy for high-risk prostate cancer: a systematic review.

Heesterman B, Aben K, de Jong I, Pos F, van der Hel O BMC Cancer. 2023; 23(1):398.

PMID: 37142955 PMC: 10157926. DOI: 10.1186/s12885-023-10842-1.

References

Thompson I, Tangen C, Paradelo J, Lucia M, Miller G, Troyer D . Adjuvant radiotherapy for pathological T3N0M0 prostate cancer significantly reduces risk of metastases and improves survival: long-term followup of a randomized clinical trial. J Urol. 2009; 181(3):956-62. PMC: 3510761. DOI: 10.1016/j.juro.2008.11.032. View

Messing E, Manola J, Yao J, Kiernan M, Crawford D, Wilding G . Immediate versus deferred androgen deprivation treatment in patients with node-positive prostate cancer after radical prostatectomy and pelvic lymphadenectomy. Lancet Oncol. 2006; 7(6):472-9. DOI: 10.1016/S1470-2045(06)70700-8. View

Wiegel T, Bottke D, Steiner U, Siegmann A, Golz R, Storkel S . Phase III postoperative adjuvant radiotherapy after radical prostatectomy compared with radical prostatectomy alone in pT3 prostate cancer with postoperative undetectable prostate-specific antigen: ARO 96-02/AUO AP 09/95. J Clin Oncol. 2009; 27(18):2924-30. DOI: 10.1200/JCO.2008.18.9563. View

Roach 3rd M, Hanks G, Thames Jr H, Schellhammer P, Shipley W, Sokol G . Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference. Int J Radiat Oncol Biol Phys. 2006; 65(4):965-74. DOI: 10.1016/j.ijrobp.2006.04.029. View

He J, Albertsen P, Moore D, Rotter D, Demissie K, Lu-Yao G . Validation of a Contemporary Five-tiered Gleason Grade Grouping Using Population-based Data. Eur Urol. 2016; 71(5):760-763. DOI: 10.1016/j.eururo.2016.11.031. View

Carrie C, Hasbini A, De Laroche G, Richaud P, Guerif S, Latorzeff I . Salvage radiotherapy with or without short-term hormone therapy for rising prostate-specific antigen concentration after radical prostatectomy (GETUG-AFU 16): a randomised, multicentre, open-label phase 3 trial. Lancet Oncol. 2016; 17(6):747-756. DOI: 10.1016/S1470-2045(16)00111-X. View

Hamdy F, Donovan J, Athene Lane J, Mason M, Metcalfe C, Holding P . 10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer. N Engl J Med. 2016; 375(15):1415-1424. DOI: 10.1056/NEJMoa1606220. View

Cupples L, Gagnon D, Ramaswamy R, DAgostino R . Age-adjusted survival curves with application in the Framingham Study. Stat Med. 1995; 14(16):1731-44. DOI: 10.1002/sim.4780141603. View

Pierorazio P, Guzzo T, Han M, Bivalacqua T, Epstein J, Schaeffer E . Long-term survival after radical prostatectomy for men with high Gleason sum in pathologic specimen. Urology. 2010; 76(3):715-21. PMC: 2897964. DOI: 10.1016/j.urology.2009.11.085. View

10.

Piccirillo J, Tierney R, Costas I, Grove L, Spitznagel Jr E . Prognostic importance of comorbidity in a hospital-based cancer registry. JAMA. 2004; 291(20):2441-7. DOI: 10.1001/jama.291.20.2441. View

11.

DAgostino Jr R . Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat Med. 1998; 17(19):2265-81. DOI: 10.1002/(sici)1097-0258(19981015)17:19<2265::aid-sim918>3.0.co;2-b. View

12.

Bolla M, van Poppel H, Tombal B, Vekemans K, Da Pozzo L, de Reijke T . Postoperative radiotherapy after radical prostatectomy for high-risk prostate cancer: long-term results of a randomised controlled trial (EORTC trial 22911). Lancet. 2012; 380(9858):2018-27. DOI: 10.1016/S0140-6736(12)61253-7. View

13.

Kishan A, Cook R, Ciezki J, Ross A, Pomerantz M, Nguyen P . Radical Prostatectomy, External Beam Radiotherapy, or External Beam Radiotherapy With Brachytherapy Boost and Disease Progression and Mortality in Patients With Gleason Score 9-10 Prostate Cancer. JAMA. 2018; 319(9):896-905. PMC: 5885899. DOI: 10.1001/jama.2018.0587. View

14.

Shipley W, Seiferheld W, Lukka H, Major P, Heney N, Grignon D . Radiation with or without Antiandrogen Therapy in Recurrent Prostate Cancer. N Engl J Med. 2017; 376(5):417-428. PMC: 5444881. DOI: 10.1056/NEJMoa1607529. View

15.

Gehan E . A GENERALIZED WILCOXON TEST FOR COMPARING ARBITRARILY SINGLY-CENSORED SAMPLES. Biometrika. 1965; 52:203-23. View

16.

Mohler J, Armstrong A, Bahnson R, DAmico A, Davis B, Eastham J . Prostate Cancer, Version 1.2016. J Natl Compr Canc Netw. 2016; 14(1):19-30. DOI: 10.6004/jnccn.2016.0004. View