Objectives: Individuals with prostate-specific antigen (PSA) levels of ≥20 ng/mL, Gleason scores of ≥8, or clinical stage T2c/T3 tumors are defined as high-risk prostate cancer (PC) patients. Treatment options for high-risk PC include external beam-radiation therapy (RT) with androgen-deprivation hormonal therapy; trimodal therapy with a combination of brachytherapy, RT, and hormonal therapy; and radical prostatectomy (RP) with neoadjuvant or adjuvant therapy. To date, no sufficiently large-scale, prospective, randomized clinical trials have compared the abovementioned treatment options. Thus, optimal management strategies for high-risk PCa patients have not been established. Therefore, this study was aimed to compare the prognoses between patients with high risk localized or locally advanced prostate cancer (PCa) treated with either radiotherapy (RT) or radical prostatectomy (RP) after a median 3.6-month neoadjuvant hormonal therapy (NHT).
Methods: Between 2003 and 2014, a total of 255 patients including 83 RT and 172 RP were enrolled to retrospectively analyze their clinical data after NHT in single institution. The definitions of BCR in each group were that PSA increase > 2 ng/mL higher than the PSA nadir value, regardless of the blood concentration of the nadir in RT group, is defined, whereas a PSA level 0.2 ng/ml following RP after a PSA “free” interval is defined in RP group. The comparison of time to biochemical recurrence (BCR), local recurrence at pelvis (LC), metastasis, clinical painful symptom progression (CPSP), castration-resistant PC (CRPC) and overall survival (OS) were statistically assessed between RT and RP using Kaplan-Meier method and log rank test with a significant p-value<0.05.
Results: The overall incidence of BCR, LC, metastasis, CPSP, and CRPC were 61.2%, 17.6%, 9.0%, 4.7%, and 8.2%, respectively. The several baseline clinicopathological characteristics between RT and RP groups were significantly different in initial PSA, diagnostic age, nadir PSA and PSA level at BCR, time to adjuvant HT, number of BCR and of adjuvant HTx (p<0.05). The Kaplan-Meier test and log rank test showed insignificant differences between RT and RP groups for median time to BCR (RT 15.0 vs 14.0 months, p=0.242), local recur (26.0 vs. 37.0 months, p=0.285), metastasis (RT 38.0 vs RP 51.0 months, p=0.674) , CPSP (27.0 vs 47.0 months, p=0.583), CRPC (RT 39.1 vs RP 45.1 months, p=0.435) and to OS (mean 138.3 vs not reached till 150 months, p=0.794).
Conclusion: In spite of different baseline TNM stage, both RT and RP had insignificantly differential prognoses in patient with PC treated with NHT, except for local recurrence. Further studies with longer follow-up duration and with large numbered patients would be required to discuss their prognoses.