Radical prostatectomy with radiotherapy cuts mortality risk in prostate cancer
Radical prostatectomy (RP) with radiotherapy (XRT) reduces the risk of disease-specific death in patients with locally (LAPCa) and regionally advanced (RAPCa) prostate cancer, a recent study shows.
Researchers enrolled 13,856 RAPCa or LAPCa patients, about half of whom were treated with a single modality alone. Most of these patients received RP alone (20.8 percent; n=2,884), followed by XRT (18.3 percent; n=2,541) and androgen deprivation therapy (APT; 11.2 percent; n=1,545) alone.
In comparison, almost 30 percent of the men received multimodal treatment: RP plus XRT (6.1 percent; n=848) and XRT plus ADT (23.6 percent; n=3,272). The remaining 20 percent (n=2,766) did not receive any treatment within 6 months of diagnosis.
After a median follow-up period of 14.6 years, researchers reported 2,189 deaths. Propensity score-adjusted Cox proportional hazards models showed that patients who underwent RP with XRT were less likely to die, both from any and prostate cancer-related causes.
For instance, disease-specific mortalities from T3aN0M0 (adjusted hazard ratio [HR], 4.22; 95 percent CI, 2.83–6.28), T4N0M0 (adjusted HR, 2.31; 1.05–5.12) and T3bN0M0 (adjusted HR, 1.84; 1.34–2.53) malignancies were significantly less likely.
Kaplan-Meier estimates further confirmed the survival benefits associated with RP plus XRT. In men with T3a/bN0-NXM0 disease, the corresponding adjusted 10-year disease-specific survival rates for RP with XRT and ADT with XRT were 88.9 percent and 74.2 percent. The resulting survival difference achieved statistical significance in favour of RP with XRT (difference, 14.7 percent; 11.4–17.2).