Primary radical prostatectomy and external beam radiation therapy (EBRT) for high-risk prostate cancer offer similar cancer-specific survival rates, according to study findings reported at the European Association of Urology’s 38th Congress in Milan, Italy.

Patients with high-risk prostate cancer are eligible for both treatments, but large-scale population-based analyses examining which treatment may improve cancer-specific survival are lacking, said Marialaura Righetto, MD, of Camposampiero Hospital in Camposampiero, Italy, who presented the findings on behalf of coauthors from the same hospital.

Dr Righetto’s group analyzed data from 2318 patients who received primary radical prostatectomy or EBRT in the control arms of 3 randomized controlled trials as well as from their prospective institutional database. They selected patients based on criteria established by the National Comprehensive Cancer Network (NCCN), which defines high-risk prostate cancer as the presence of at least 1 of the following features: Gleason grade group 4 or 5 classification, a PSA level above 20 ng/mL, or clinical stage cT3 or higher cancer.

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The investigators only included patients without metastatic or node-positive disease. The study population included 1740 patients (75%) who underwent radical prostatectomy and 578 (25%) who received EBRT. The median follow-up duration was 81 months and 79 months for the radical prostatectomy and EBRT groups, respectively.

The investigators used propensity score weighting to match patients in each group according to age, race, clinical stage, baseline PSA, Gleason score at prostate biopsy, comorbidities, and concomitant drug therapies. The 5-year cancer-specific survival rates were 3.6% and 4.9% for the radical prostatectomy and EBRT groups, respectively, a between-group difference that was not statistically significant, Dr Righetto reported. The investigators also found no statistical difference in the rates on multivariable analysis.

Although the main study limitation was a high proportion of patients with missing data, Dr Righetto said “our data does not support an advantage in cancer-specific survival for NCCN high-risk prostate cancer patients undergoing radical prostatectomy compared to those receiving primary EBRT.”


Righetto M, Fulconli V, Modonutti D, Costa G. Cancer-specific survival following radical prostatectomy versus radiation therapy in high-risk prostate cancer patients: A multi-trial cohort analysis. Presented at: EAU23, Milan, Italy, March 10-13, 2023. Abstract A0253.