Cancer-directed surgery brings survival benefits for patients with advanced prostate cancer: a population-based propensity-score matching study

Purpose: The purpose of this study was to evaluate the survival benefits of cancer-directed surgery (CDS) for localized prostate cancer (PCa) as well as advanced PCa. Methods: We retrospectively used the Surveillance, Epidemiology, and End Results (SEER) database and conducted a propensity score matching (PSM) study to investigate survival benefits and influencing factors of CDS in patients with PCa, especially for those with advanced PCa. Results: 19,729 cases were included. Patients who were recommended CDS had lower stages of disease (81.01% vs. 77.32% at stages I and II, p<0.01) than those who were not recommended CDS. It was primarily age, diagnosis year, cancer stage (American Joint Committee on Cancer Staging System), Gleason score, race, and home location and prostate-specific antigen, that influenced whether CDS was recommended or not (all p<0.05). Patients with PCa had lower rates of cancer specific mortality (CSM) and overall mortality (OM) when CDS was performed (CDS performed=CDSP). The unselected patients with CDSP decreased both rates of CSM by 79% and OM by 26% (both p<0.001). CDSP also benefited the young patients (with age ≤74 years old) with stage IV disease, promoting a rate decrease by 28% in CSM and by 31% in OM (both p<0.001). Conclusions: We found a decline in CSM and OM for unselected patients with PCa and patients less than 74 years old with stage IV disease. CDS as part of a multimodal treatment concept should be considered for an alternative treatment for patients with advanced PCa.