Survival Outcomes of Radical Prostatectomy vs EBRT in Prostate Cancer Patients With Gleason Score 9–10 at Biopsy

[Balsam01]

TAKE-HOME MESSAGE

•The authors compared cancer-specific mortality (CSM) in men in the SEER database with Gleason score 9–10 prostate cancer treated with external beam radiation therapy (EBRT) versus radical prostatectomy (RP) between 2004 and 2015. A total of 29% of the 9007 men undergoing RP underwent adjuvant radiation therapy. Those undergoing EBRT had significantly higher all-cause 10-year mortality rates (31% vs 12%; P<.001), reflecting their greater baseline comorbidity. However, there were no differences in 10-year CSM (20% for both groups) on unadjusted or adjusted analyses (HR, 0.93; P=.2). A matched analysis of men undergoing RP not requiring adjuvant RT and those undergoing primary EBRT did demonstrate improved 10-year CSM for those undergoing RP (16% vs 18%; HR, 0.76; P<.001).

•RP and EBRT are associated with similar 10-year CSM in men with Gleason score 9–10 prostate cancer, although those men who will not require adjuvant RT may fare better with RP than with primary EBRT.

- Joshua Cohn, MD

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.

Urologic Oncology: Seminars & Original Investigations

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

Urol. Oncol 2019 Oct 22;[EPub Ahead of Print], S Knipper, C Palumbo, A Pecoraro, G Rosiello, Z Tian, A Briganti, KC Zorn, F Saad, D Tilki, M Graefen, PI Karakiewicz

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

[Fairwind]

So what percentage of Gleason 9 & 10 people are still alive 10 years after diagnosis regardless of the treatment they underwent ? Looks to me like only 20% make it to the ten year mark no matter what treatments they chose....

[Magnus1964 in reply to Fairwind]

Me. Gleason score 9. I had the orchiectomy, then EBRT 4 years later. I am still here 27 years later.

[Hidden in reply to Magnus1964]

Magnus you’re a miracle and an anomaly .. I salute you .

[FightTillTheEnd in reply to Magnus1964]

Thanks for sharing Magnus. Guys like you are a real inspiration for noobs like myself!

[JimBarringer in reply to Fairwind]

Dx more than 14 years ago. Gleason 9. 40 rounds radiation. Have had keytruda clinical trial, thirteen rounds of chemo and will have 4th round of Lu-177 in vision trial in a couple of weeks. Still able to take the dog for a good walk most days. Hang in there brothers.

[FightTillTheEnd in reply to JimBarringer]

Heck, well done Jim!

[edwardmosner]

10 years and counting. Gleason of 9+ had RP & radiation. Been through 10 years of ADT , Provenge, Erleada. Currently on Zytiga. Still here, above ground and vertical.

[j-o-h-n]

A decade or deadade?

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 11/20/2019 8:00 PM EST

[tallguy2]

A mere 7 years since DX, Gleason 9, RP, EBRT ( 2 times), taxotere chemo, Provenge. Next step is a Phase II clinical trial. Never give up!