Departments of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA.
Department of Urology, Ain Shams University, Cairo, Egypt.
Prostate. 2021 Mar;81(4):223-230. doi: 10.1002/pros.24089. Epub 2021 Jan 20.
To compare the oncologic outcomes of radical prostatectomy (RP) versus external beam radiotherapy (EBRT) ± androgen deprivation therapy for primary treatment of high risk localized prostate cancer (CaP).
We retrospectively reviewed a prospectively-populated database for cases who underwent primary treatment for high risk localized CaP, had more than 2 years follow-up, and were treated since 2006. A total of 335 cases were studied of whom 291 underwent RP and 44 underwent EBRT. Clinical characteristics, biochemical progression-free survival (BPFS), metastasis-free survival (MFS), cancer-specific survival (CSS) and overall survival (OS) were compared.
EBRT cases were older (p < .01; mean 71 years vs. 61 years) and had longer PSA doubling time (PSADT) (p = .03; median 4.8 years vs. 3.5 years) than RP. Race, pretreatment PSA and biopsy Gleason score were similar. Median follow-up was 5.1 (range: 2.3-12.8) years for RP versus 3.3 (range: 2-12.4) years for EBRT. Three- and 5-year BPFS were 42% and 36% after RP versus 86% and 75% after EBRT (p < .01). The rate of adjuvant/salvage therapy was 58% after RP versus 20% after EBRT (p < .01). Three- and 5-year MFS were 80% and 77% after RP versus 91% and 91% after EBRT (p = .11). Three-year CSS was 98% in both groups and OS was 97% after RP versus 94% after EBRT (p = .73).
RP had higher rates of biochemical failure and adjuvant or salvage treatment versus EBRT in high risk localized CaP. MFS trended toward benefit after EBRT, but CSS and OS remained high in both groups.
比较根治性前列腺切除术（RP）与外照射放疗（EBRT）±雄激素剥夺治疗在原发性高危局限性前列腺癌（CaP）治疗中的肿瘤学结局。
我们回顾性分析了自 2006 年以来接受原发性高危局限性 CaP 治疗、随访时间超过 2 年且接受治疗的前瞻性数据库中的病例。共研究了 335 例病例，其中 291 例行 RP，44 例行 EBRT。比较了临床特征、生化无进展生存率（BPFS）、无转移生存率（MFS）、癌症特异性生存率（CSS）和总生存率（OS）。
EBRT 组年龄较大（p<.01；平均 71 岁比 61 岁），PSA 倍增时间（PSADT）较长（p=.03；中位数 4.8 年比 3.5 年）。种族、预处理 PSA 和活检 Gleason 评分相似。RP 组中位随访时间为 5.1（范围：2.3-12.8）年，EBRT 组为 3.3（范围：2-12.4）年。RP 组的 3 年和 5 年 BPFS 分别为 42%和 36%，EBRT 组分别为 86%和 75%（p<.01）。RP 组辅助/挽救治疗率为 58%，EBRT 组为 20%（p<.01）。RP 组的 3 年和 5 年 MFS 分别为 80%和 77%，EBRT 组分别为 91%和 91%（p=.11）。两组的 3 年 CSS 均为 98%，RP 组的 OS 为 97%，EBRT 组为 94%（p=.73）。
在高危局限性 CaP 中，RP 与 EBRT 相比，生化失败率和辅助/挽救治疗率更高。EBRT 后 MFS 呈获益趋势，但两组的 CSS 和 OS 仍较高。
