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Comparison of Clinical Outcomes of Radical Prostatectomy versus IMRT with Long-Term Hormone Therapy for Relatively Young Patients with High- to Very High-Risk Localized Prostate Cancer

SIMPLE SUMMARY: That the definitive optimal treatments for relatively young men (aged ≤ 65 years) with high- or very high-risk localized prostate cancer (HR/VHR-LPC) are radical prostatectomy (RP) or radiation plus antiandrogen therapy (RT-ADT) is controversial. To the best of our knowledge, our stu...

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Autores principales: Shih, Hung-Jen, Chang, Shyh-Chyi, Hsu, Chia-Hao, Lin, Yi-Chu, Hung, Chu-Hsuan, Wu, Szu-Yuan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8656593/
https://www.ncbi.nlm.nih.gov/pubmed/34885096
http://dx.doi.org/10.3390/cancers13235986
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author Shih, Hung-Jen
Chang, Shyh-Chyi
Hsu, Chia-Hao
Lin, Yi-Chu
Hung, Chu-Hsuan
Wu, Szu-Yuan
author_facet Shih, Hung-Jen
Chang, Shyh-Chyi
Hsu, Chia-Hao
Lin, Yi-Chu
Hung, Chu-Hsuan
Wu, Szu-Yuan
author_sort Shih, Hung-Jen
collection PubMed
description SIMPLE SUMMARY: That the definitive optimal treatments for relatively young men (aged ≤ 65 years) with high- or very high-risk localized prostate cancer (HR/VHR-LPC) are radical prostatectomy (RP) or radiation plus antiandrogen therapy (RT-ADT) is controversial. To the best of our knowledge, our study is the first and largest to examine biochemical failure (BF), all-cause death, locoregional recurrence, and distant metastasis in relatively young men with HR/VHR-LPC as defined by National Comprehensive Cancer Network risk strata. After head-to-head propensity score matching was used to balance the potential confounders, a multivariable Cox proportional hazards regression model was used to analyze oncologic outcomes. In relatively young men with HR/VHR-LPC, RP and RT-ADT yielded similar oncologic outcomes and RP reduced the risk of BF compared with RT-ADT. ABSTRACT: That intensity-modulated radiotherapy (IMRT) plus antiandrogen therapy (IMRT-ADT) and radical prostatectomy (RP) are the definitive optimal treatments for relatively young patients (aged ≤ 65 years) with high- or very high-risk localized prostate cancer (HR/VHR-LPC), but remains controversial. We conducted a national population-based cohort study by using propensity score matching (PSM) to evaluate the clinical outcomes of RP and IMRT-ADT in relatively young patients with HR/VHR-LPC. Methods: We used the Taiwan Cancer Registry database to evaluate clinical outcomes in relatively young (aged ≤ 65 years) patients with HR/VHR-LPC, as defined by the National Comprehensive Cancer Network risk strata. The patients had received RP or IMRT-ADT (high-dose, ≥72 Gy plus long-term, 1.5–3 years, ADT). Head-to-head PSM was used to balance potential confounders. A Cox proportional hazards regression model was used to analyze oncologic outcomes. Results: High-dose IMRT-ADT had a higher risk of biochemical failure (adjusted hazard ratio [aHR] = 2.03, 95% confidence interval [CI] 1.56–2.65, p < 0.0001) compared with RP; IMRT-ADT did not have an increased risk of all-cause death (aHR = 1.2, 95% CI 0.65–2.24, p = 0.564), locoregional recurrence (aHR = 0.88, 95% CI 0.67–1.06, p = 0.3524), or distant metastasis (aHR = 1.03, 95% CI 0.56–1.9, p = 0.9176) compared with RP. Conclusion: In relatively young patients with HR/VHR-LPC, RP and IMRT-ADT yielded similar oncologic outcomes and RP reduced the risk of biochemical failure compared with IMRT-ADT.
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spelling pubmed-86565932021-12-10 Comparison of Clinical Outcomes of Radical Prostatectomy versus IMRT with Long-Term Hormone Therapy for Relatively Young Patients with High- to Very High-Risk Localized Prostate Cancer Shih, Hung-Jen Chang, Shyh-Chyi Hsu, Chia-Hao Lin, Yi-Chu Hung, Chu-Hsuan Wu, Szu-Yuan Cancers (Basel) Article SIMPLE SUMMARY: That the definitive optimal treatments for relatively young men (aged ≤ 65 years) with high- or very high-risk localized prostate cancer (HR/VHR-LPC) are radical prostatectomy (RP) or radiation plus antiandrogen therapy (RT-ADT) is controversial. To the best of our knowledge, our study is the first and largest to examine biochemical failure (BF), all-cause death, locoregional recurrence, and distant metastasis in relatively young men with HR/VHR-LPC as defined by National Comprehensive Cancer Network risk strata. After head-to-head propensity score matching was used to balance the potential confounders, a multivariable Cox proportional hazards regression model was used to analyze oncologic outcomes. In relatively young men with HR/VHR-LPC, RP and RT-ADT yielded similar oncologic outcomes and RP reduced the risk of BF compared with RT-ADT. ABSTRACT: That intensity-modulated radiotherapy (IMRT) plus antiandrogen therapy (IMRT-ADT) and radical prostatectomy (RP) are the definitive optimal treatments for relatively young patients (aged ≤ 65 years) with high- or very high-risk localized prostate cancer (HR/VHR-LPC), but remains controversial. We conducted a national population-based cohort study by using propensity score matching (PSM) to evaluate the clinical outcomes of RP and IMRT-ADT in relatively young patients with HR/VHR-LPC. Methods: We used the Taiwan Cancer Registry database to evaluate clinical outcomes in relatively young (aged ≤ 65 years) patients with HR/VHR-LPC, as defined by the National Comprehensive Cancer Network risk strata. The patients had received RP or IMRT-ADT (high-dose, ≥72 Gy plus long-term, 1.5–3 years, ADT). Head-to-head PSM was used to balance potential confounders. A Cox proportional hazards regression model was used to analyze oncologic outcomes. Results: High-dose IMRT-ADT had a higher risk of biochemical failure (adjusted hazard ratio [aHR] = 2.03, 95% confidence interval [CI] 1.56–2.65, p < 0.0001) compared with RP; IMRT-ADT did not have an increased risk of all-cause death (aHR = 1.2, 95% CI 0.65–2.24, p = 0.564), locoregional recurrence (aHR = 0.88, 95% CI 0.67–1.06, p = 0.3524), or distant metastasis (aHR = 1.03, 95% CI 0.56–1.9, p = 0.9176) compared with RP. Conclusion: In relatively young patients with HR/VHR-LPC, RP and IMRT-ADT yielded similar oncologic outcomes and RP reduced the risk of biochemical failure compared with IMRT-ADT. MDPI 2021-11-28 /pmc/articles/PMC8656593/ /pubmed/34885096 http://dx.doi.org/10.3390/cancers13235986 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Shih, Hung-Jen
Chang, Shyh-Chyi
Hsu, Chia-Hao
Lin, Yi-Chu
Hung, Chu-Hsuan
Wu, Szu-Yuan
Comparison of Clinical Outcomes of Radical Prostatectomy versus IMRT with Long-Term Hormone Therapy for Relatively Young Patients with High- to Very High-Risk Localized Prostate Cancer
title Comparison of Clinical Outcomes of Radical Prostatectomy versus IMRT with Long-Term Hormone Therapy for Relatively Young Patients with High- to Very High-Risk Localized Prostate Cancer
title_full Comparison of Clinical Outcomes of Radical Prostatectomy versus IMRT with Long-Term Hormone Therapy for Relatively Young Patients with High- to Very High-Risk Localized Prostate Cancer
title_fullStr Comparison of Clinical Outcomes of Radical Prostatectomy versus IMRT with Long-Term Hormone Therapy for Relatively Young Patients with High- to Very High-Risk Localized Prostate Cancer
title_full_unstemmed Comparison of Clinical Outcomes of Radical Prostatectomy versus IMRT with Long-Term Hormone Therapy for Relatively Young Patients with High- to Very High-Risk Localized Prostate Cancer
title_short Comparison of Clinical Outcomes of Radical Prostatectomy versus IMRT with Long-Term Hormone Therapy for Relatively Young Patients with High- to Very High-Risk Localized Prostate Cancer
title_sort comparison of clinical outcomes of radical prostatectomy versus imrt with long-term hormone therapy for relatively young patients with high- to very high-risk localized prostate cancer
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8656593/
https://www.ncbi.nlm.nih.gov/pubmed/34885096
http://dx.doi.org/10.3390/cancers13235986
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