Radical prostatectomy (RP) is associated with improved cancer-specific survival compared with external beam radiation therapy (EBRT) among men with high-risk prostate cancer, a new study finds.

Investigators led by Francesco Chierigo, MD, of Policlinico San Martino Hospital, University of Genova in Genova, Italy, first studied cancer-specific mortality (CSM) rates among 24,407 patients at high risk according to National Comprehensive Cancer Network criteria using the 2010-2016 Surveillance, Epidemiology, and End Results database. Second, they studied the same patients stratified by Johns Hopkins University criteria for high-risk (cT3a or Gleason Grade Group 4-5 or PSA exceeding 20 ng/mL) and very high risk (cT3b-cT4 or primary Gleason pattern 5 or Gleason Grade Group 4-5 in 5 or more biopsy cores) prostate cancer. To minimize confounding, patients were propensity score matched by age, PSA, biopsy Gleason score, and clinical T and N stages. The investigators also adjusted for mortality from other causes as a proxy for comorbidity burden.

In the entire NCCN high-risk cohort, 40% underwent RP and 60% underwent EBRT. At 5 years, CSM rates were lower among patients treated with surgery instead of radiation: 2.3% RP vs 4.1% EBRT. RP was significantly associated with a 32% reduced risk for CSM, Dr Chierigo and colleagues reported in The Journal of Urology.

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Using Johns Hopkins criteria, 5-year CSM rates among very high-risk patients were 3.5% for RP compared with 6.0% for EBRT. RP was significantly associated with a 42% reduced risk for CSM, the investigators reported. No significant difference in CSM rates was found between RP vs EBRT in the Johns Hopkins high-risk group. It is possible that the small sample lacked statistical power to detect a difference, according to the investigators.

The data suggest that RP holds a CSM advantage over EBRT in the combined NCCN high-risk cohort, and in its subgroup of Johns Hopkins very high-risk patients, according to Dr Chierigo’s team.


Chierigo F, Wenzel M, Würnschimmel C, et al. Survival after radical prostatectomy vs. radiation therapy in high-risk and very high-risk prostate cancer. J Urol. doi:10.1097/JU.0000000000002250