Radical prostatectomy vs. external beam radiation therapy in Gleason 9-10.

[pjoshea13]

New German/Italian/Canadian study below [1].

"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."

"... 8,890 (49.7%) underwent EBRT vs. 9,007 (50.3%) underwent RP. Of those, 2,584 (28.7%) received aRT ..."

"... 10 year {cancer-specific mortality} rates were 19.9% vs. 19.6% ... and 10 year other-cause mortality rates were 11.5% vs. 31.2%, respectively, in RP vs. EBRT patients .."

"... within RP-only vs. EBRT patients, RP represented an independent predictor of lower {cancer-specific mortality} (HR: 0.76 ...)"

-Patrick

[1] ncbi.nlm.nih.gov/pubmed/316...

Urol Oncol. 2019 Oct 22. pii: S1078-1439(19)30366-7. doi: 10.1016/j.urolonc.2019.09.015. [Epub ahead of print]

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.

Knipper S1, Palumbo C2, Pecoraro A3, Rosiello G4, Tian Z5, Briganti A6, Zorn KC7, Saad F5, Tilki D8, Graefen M9, Karakiewicz PI5.

Author information

1

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: [e-mail].

2

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.

3

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.

4

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.

5

Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada.

6

Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.

7

Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada; Brunswick Science and Technology, Montreal, Quebec, Canada.

8

Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.

9

Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.

Abstract

PURPOSE:

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.

METHODS:

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).

RESULTS:

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).

CONCLUSIONS:

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.

Copyright © 2019 Elsevier Inc. All rights reserved.

KEYWORDS:

Cancer-specific survival; Grade group V; Local treatment; Localized prostate cancer; SEER

PMID: 31653563 DOI: 10.1016/j.urolonc.2019.09.015

[GranPaSmurf]

So, it's a toss up, right?

I'm a couple of weeks from finishing Radiation Therapy. Pee every 20 minutes and gut won't hold s**t!

Counting down.

[snoraste]

I think, not having seen the population details, one can argue that people doing RP are generally “healthier”, because they are vetted to tolerate a surgical procedure. Not saying the case in here, just not sure.

[Gemlin_]

If someone is evaluating these two alternatives, he should also evaluate the alternative "brachytherapy combined with external beam radiation therapy w/wo ADT" (BT + EBRT + ADT). Some studies have found superior result for that treatment. Dramatically polarized opinions among experts.

[Hidden]

A bit tricky way of presenting things.

If the two cohorts have, within reason, equal outcomes and a sub-group of RP (this with no RT) scored better, than, 5th grade maths say that the other sub-group (that with RT) scored worse.

I have been saying to doctors and most of them have been deeply offended by this, that RP is a very costly (both in money and in QOL) form of biopsy for probing the aggressiveness of the disease.

And this is the real message out of this publication. Men take the RP-test and if they fare well don't need adjuvent or early RT. They live longer because their disease was less aggressive.

Elementary Watson!

[j-o-h-n in reply to Hidden]

No shit Sherlock...........

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 10/30/2019 5:38 PM DST