潘 岳¹、李良明¹、林克勳¹、林雍偉¹、蕭志豪¹、溫玉清^{1, 2}

臺北市立萬芳醫院 泌尿科¹ 臺北醫學大學 醫學院 泌尿學科²

Surgery versus radiotherapy or radiotherapy with androgen deprivation therapy in the management of intermediate-risk or high-risk prostate cancer

Pan Yueh¹, Liang-Ming Lee¹, Ke-Hsun Lin¹, Yung-Wei Lin¹, Chi-Hao Hsiao¹, Yu-Ching Wen^{1, 2}

¹Division of Urology, Taipei Municipal Wanfang Hospital, Taipei, Taiwan

²Department of Urology, School of Medicine, College of Medicine, Taipei Medical University

 

Purpose: Optimal treatment of intermediate-risk or high-risk prostate cancer remains controversial. We compare treatment outcomes of prostate cancer patients treated with radical prostatectomy (RP), external-beam radiotherapy (RT) or RT with androgen deprivation therapy (ADT).

Materials and Methods: This retrospective study comprised 641 men with prostate cancer from 2008 to 2018. Of 641 men, 211 men were intermediate-risk or high-risk. Treatment options were radical prostatectomy (RP), external-beam radiotherapy (RT) or RT with ADT. Biochemical recurrence free survival (BRFS), cancer-specific survival (CSS) and overall survival (OS) were analyzed. Kaplan-Meier method and log-rank test was performed for survival analysis.

Results: Of 211 intermediate-risk or high-risk patients, 48 patients underwent RP, 29 patients underwent RT alone and 134 patients received RT with ADT. Median age (years) of RP group was younger than RT alone or RT with ADT (RP: 68, RT: 75, RT+ADT: 76, p < 0.001). Median PSA levels (ng/mL) were (RP: 11.92, RT: 7.77, RT+ADT: 17.11, p < 0.001). Gleason score of RT alone group was lower than RP group and RT with ADT group (RP: 7, RT: 6, RT+ADT: 7, p < 0.001). Clinical T stage of RT with ADT group was higher than RP group and RT alone group (p = 0.001). Median follow-up time (months) were 72.27 (RP: 64, RT: 68.73, RT+ADT: 48.48, p = 0.3). CSS and BRFS (years) were similar in three treatment groups (mean of CSS were as below RP: 10.99, RT: 9.4, RT+ADT: 10.26, p = 0.5; mean of BRFS were as below RP: 7.92, RT: 7.64, RT+ADT: 7.89, p = 1.0). Overall survival (years) was significantly higher in RP group (mean of OS were as below RP: 10.99, RT: 8.17, RT+ADT: 8.83). Hazard ratio for death (RP/RT): 0.089 (95% CI, 0.028-0.28), (RP/RT+ADT): 0.1 (95% CI, 0.044-0.24), log-rank test p = 0.016. 

Conclusions: Cancer-specific survival and biochemical recurrence free survival were similar in three treatment groups in intermediate-risk or high-risk prostate cancer patients. However, overall survival was significantly longer in RP group than in RT and in RT with ADT group.