Comparative Effectiveness of Radical Prostatectomy Versus External Beam Radiation Therapy Plus Brachytherapy in Patients with High-risk Localized Prostate Cancer.

Abstract

A previous study comparing external beam radiation therapy with/without brachytherapy (EBRT±BT) and radical prostatectomy (RP) for high-risk localized prostate cancer (PCa) did not find a difference in overall survival (OS) between the treatments. However, this study was limited by short follow-up and assessment of OS in patients of divergent age and comorbidities. We therefore compared OS of EBRT+BT versus RP in comparatively young (≤65yr) and healthy men (Charlson Comorbidity Index=0) with high-risk localized PCa in the National Cancer Database. Inverse probability of treatment weighting (IPTW) adjustment was used to balance baseline characteristics. Median follow-up was 92mo (interquartile range 78-108). Using IPTW-adjusted Cox regression analysis, EBRT+BT was associated with a higher risk of all-cause mortality compared with RP (hazard ratio=1.22, 95% confidence interval 1.05-1.43). In young and healthy men presenting with high-risk localized PCa, RP showed statistically significant OS benefit compared with EBRT+BT. PATIENT SUMMARY: In an analysis restricted to young and healthy men presenting with high-risk localized prostate cancer, initial radical prostatectomy is associated with an overall survival benefit compared with external beam radiation therapy plus brachytherapy.