局部及區域晚期攝護腺癌的治療策略：如何兼顧生存與生活

劉永浩, 黎赫, 高建璋, 曹智惟, 楊明昕

三軍總醫院 外科部 泌尿外科

Treatment Optimization for Locally and Regionally Advanced Prostate Cancer: Balancing Survival and Quality of Life

Liu Yung-Hao, Li Ho, Kao Chien-Chang, Tsao Chih-Wei, Yang Ming-Hsin

Division of Urology, Department of Surgery, Tri‐Service General Hospital, National Defense Medical Center, Taipei, Taiwan

Background:
Men diagnosed with locally advanced prostate cancer (LAPCa) or regionally advanced prostate cancer (RAPCa) face significant mortality risks. Current clinical guidelines advocate for multimodal treatment strategies, including radical prostatectomy (RP) followed by radiotherapy (RT) and RT combined with androgen deprivation therapy (ADT). However, comparative data on these treatment modalities remain limited, particularly in Asian populations. Moreover, the increasing use of robotic-assisted radical prostatectomy (RARP) may impact surgical precision, complication rates, and functional outcomes, potentially altering treatment-related morbidity and survival. This study aims to evaluate the survival outcomes, adverse effects, and quality of life (QoL) in patients receiving RP plus RT versus RT plus ADT in a single-institution cohort.

Methods:
This retrospective cohort study included 252 patients diagnosed with cT3-T4N0M0 (LAPCa) or cT3-T4N1M0 (RAPCa) prostate cancer between 2014-2024. Propensity score matching was applied to balance baseline characteristics between the two treatment groups. Survival outcomes were analyzed using the Kaplan-Meier method, and multivariable Cox proportional hazards models were employed to assess the impact of treatment modality on cancer-specific and overall survival. Adverse effects, including erectile dysfunction and urinary incontinence, were documented through follow-up records. QoL outcomes were evaluated using validated patient-reported measures.

Results:

From 2014 to 2024, 252 men (≥60 years old) were diagnosed with LAPCa or RAPCa: 59% received RP plus RT, and 41% received RT plus ADT. Regardless of the tumor stage or the Gleason score, the adjusted 5-year prostate cancer–specific survival and 5-year overall survival favored men who underwent RP plus RT over men who underwent RT plus ADT. However, RARP plus XRT versus XRT plus ADT was associated with poorer quality of life.

Conclusions:

Men with LAPCa or RAPCa treated initially with RP plus RT had a lower risk of prostate cancer–specific death and improved overall survival in comparison with those men treated. However, with RARP, pateints experienced poorer quality of life.