Combination radiation therapy and radical prostatectomy (RP) for Gleason score 9 to 10 prostate cancer are associated with similar prostate-cancer specific mortality (PCSM), investigators reported during the American Urological Association’s 2020 Virtual Experience. Risk-tailored surgical management, however, may be associated with significantly better PCSM.
Using the Surveillance, Epidemiology, and End Results (SEER) database, Edward Christopher Dee, BS, of Dana-Farber Cancer Institute in Boston, and colleagues identified 8934 patients with high-grade PCa managed with RP with or without adjuvant radiation therapy (+/- ART) and 1462 managed with combination radiation therapy (ComboRT; external beam radiation therapy plus brachytherapy boost).
At 5 years, prostate cancer-specific mortality (PCSM) was not significantly different between the RP (+/- ART) and ComboRT groups: 6.9% vs 8.1%, the team reported. However, after excluding 4527 RP patients with adverse pathology (pT3-4 or positive surgical margins) who did not receive adjuvant RT, the investigators found that patients with organ-confined disease and negative surgical margins managed surgically (with or without adjuvant RT) or patients with adverse pathology managed with adjuvant RT had significantly improved 5-year with PCSM compared with patients treated with ComboRT (5.3% vs 8.1%). In adjusted analyses, RP +/-ART was significantly associated with a 26% decreased risk of cancer-related death.
In patients with Gleason 9 to 10 cancer, risk-tailored surgical management may offer better cancer survival, Dr Dee’s team stated. “Post-RP adjuvant RT may be especially important in the setting of Gleason score 9-10 disease with adverse pathology, which can occur in a large fraction of this patient population.”
Dee E, King M, Butler S, et al. Surgical management versus combination radiotherapy in Gleason score 9-10 prostate cancer. Presented at the American Urological Association 2020 Virtual Experience, May 15-19, 2020. Abstract MP53-10.