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

Abstract

Purpose. To compare oncologic outcomes for patients with Gleason score (GS) ≥ 8 prostate adenocarcinoma treated with radical prostatectomy (RP) versus external beam radiotherapy combined with androgen deprivation (RT + ADT). Methods. Between 2001 and 2014, 121 patients with GS ≥ 8 were treated at our institution via RT + ADT (n = 71) or RP (n = 50) with ≥ 1 year of biochemical follow-up. Endpoints included biochemical failure (BF), distant metastasis, and initiation of salvage ADT. Results. The RT + ADT group was older, had higher biopsy GS, and had greater risk of lymph node involvement. All other pretreatment characteristics were similar between groups. Mean number of lymph nodes (LNs) sampled for patients undergoing RP was 8.2 (±6.18). Mean biochemical follow-up for all patients was 61 months. Five-year estimates of BF for the RT + ADT and RP groups were 7.2% versus 42.3%, (p < 0.001). The RT + ADT group also had lower rates of distant metastasis (2% versus 7.8%) and salvage ADT (8% versus 33.8%). Conclusion. In this analysis, RT + ADT was associated with improved biochemical and metastatic control when compared to RP with limited LN sampling. How RT + ADT compares with more aggressive lymphadenectomy, as is currently our institutional standard, remains an important unanswered question.

The efficacy and safety of radical prostatectomy and radiotherapy in high-risk prostate cancer: a systematic review and meta-analysis

“…According to our analysis, the types of RT could affect the survival and progression of patients. In fact, several RCT demonstrated a BRFS benefit to EBRT + BT over EBRT [45][46][47] and several retrospective studies have reported that EBRT + BT brought better outcome than RP on BRFS [39,48,49] and MFS [35,36,38,50]. It was not difficult to find that EBRT + BT had strong control over disease progression, which might lead to better CSS for patients treated with EBRT + BT than patients treated with RP.…”

The role of radical prostatectomy and definitive external beam radiotherapy in combined treatment for high-risk prostate cancer: a systematic review and meta-analysis

“…Ten studies 15 16 17 19 21 22 24 25 27 28 provided data of EBRT modality, such as conventional EBRT, three dimensional conformal radiation therapy, and intensity modulated radiation therapy. Radiation dosage was only mentioned in 15 15 16 17 18 19 20 21 22 23 24 25 27 28 29 31 of 17 studies and mostly ranged from 60 to 80 gray (Gy, J kg −1 ). In addition, considerable variability was found in the use of adjuvant or salvage therapies, regardless of the modality or duration.…”

“…Of the 17 studies included, 16 were retrospective 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 and one was a RCT. 15 The RCT scored three out of five points (considered as high quality) according to the Jadad Scale.…”

“…Eight studies 16 17 18 20 21 25 27 30 with a total of 3701 patients were involved in the assessment. Meta-analysis showed that the patients might benefit from EBRT-based treatment with a lower risk of biochemical failure ( Figure 2a ).…”

The effect of surgery and radiotherapy on oncological outcomes in high-risk prostate cancer

“…Fakat yüksek riskli olgularda suboptimal PSA kontrolü ve sağ kalım oranları elde edilebilmektedir. Bu grup hastalarda, çoğu merkezde iki tedavi yaklaşımından biri seçilmektedir: cerrahi (RRP) veya radyoterapi (RT) + androjen deprivasyon tedavisi (ADT) (4,5).…”