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

Balsam01 profile image
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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.

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Fairwind profile image
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 profile image
Magnus1964 in reply toFairwind

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

in reply toMagnus1964

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

FightTillTheEnd profile image
FightTillTheEnd in reply toMagnus1964

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

JimBarringer profile image
JimBarringer in reply toFairwind

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 profile image
FightTillTheEnd in reply toJimBarringer

Heck, well done Jim!

edwardmosner profile image
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 profile image
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 profile image
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!

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