High-grade prostate adenocarcinoma (Gleason Score ≥8): survival and disease control following radical prostatectomy versus radiotherapy plus long-course hormone therapy

Abstract

Objective The optimal primary intervention for treatment of clinically localized high-grade prostate cancer remains to be identified. The present investigation compares disease control in patients treated with primary radical prostatectomy (RP) versus radiotherapy (RT). Methods Eligible patients were identified by Gleason 8-10 prostate adenocarcinoma at biopsy between 2003 and 2010, treated with either primary RP or RT. Patients with PSA ≥30 or clinically evident seminal vesicle or lymph node involvement at diagnosis or follow-up ≤24 months were excluded. Contemporary definitions of disease recurrence were employed. Results Between 2003 and 2010, 116 patients with Gleason 8-10 prostate cancer were identified, of whom 87 were eligible for the present analysis (41 RP, 46 RT + HT). Excepting age (RP younger), demographic factors were similar between groups. Three RP patients received immediate post-operative RT. All but one RT patient received hormone therapy (hereafter, RT + HT; median 27.5 months; 85 % >12 months, 30 % >30 months). At a median follow-up of 54 months (similar between groups), 39 patients had experienced disease recurrence (30 RP, 9 RT + HT). Estimated 5-year disease control was superior for RT + HT (21 vs. 74 %; p<0.001), without difference in cancer-specific survival (89 vs. 95 %; p=0.844). Conclusion RT + HT-based treatment of high-grade prostate cancers demonstrates superior disease control compared with RP, without impact on disease-specific survival at 5 years. Further investigation is warranted in order to identify subset patient populations who may experience differential benefit from each approach.

Pelvic Radiotherapy versus Radical Prostatectomy with Limited Lymph Node Sampling for High-Grade Prostate Adenocarcinoma

“…RT with 2-3 years of ADT is now a NCCN category 1 recommendation for patients with a high-risk of recurrence [ 1 ] based on randomized trial data showing decreased rates of clinical progression and increased overall survival compared to patients not receiving ADT [ 17 ]. A more recent study by Watkins et al reported markedly higher 5-year BF rates of 79.4% for RP and 25.2% for RT + ADT, compared to the current study, and did not report metastatic outcomes [ 16 ]. These results are likely due a lower percentage of RP patients receiving adjuvant RT and a difference in the definition of BF for patients receiving salvage RT [ 16 ].…”

“…A more recent study by Watkins et al reported markedly higher 5-year BF rates of 79.4% for RP and 25.2% for RT + ADT, compared to the current study, and did not report metastatic outcomes [ 16 ]. These results are likely due a lower percentage of RP patients receiving adjuvant RT and a difference in the definition of BF for patients receiving salvage RT [ 16 ]. In contrast to the study by Watkins et al, patients in our study that received salvage RT were not scored as BF unless they experienced PSA relapse after completion of RT [ 16 ].…”

“…Even fewer studies have compared the biochemical and metastatic outcomes of patients with GS ≥ 8 disease treated with RP versus RT + ADT. Two retrospective studies have investigated outcomes of patients with GS ≥ 8 [ 15 , 16 ]. Ramahi et al reported 5-year distant metastasis and 5-year RP BF rates similar to our current study [ 15 ].…”

“…These results are likely due a lower percentage of RP patients receiving adjuvant RT and a difference in the definition of BF for patients receiving salvage RT [ 16 ]. In contrast to the study by Watkins et al, patients in our study that received salvage RT were not scored as BF unless they experienced PSA relapse after completion of RT [ 16 ].…”