Primary treatment of locally or regionally advanced prostate cancer (PCa) with radical prostatectomy and adjuvant radiotherapy is associated with a lower risk of cancer-specific death and improved overall survival compared with primary treatment consisting of radiotherapy plus androgen deprivation therapy (ADT), new study findings suggest.

Radical prostatectomy (RP) and adjuvant radiotherapy (XRT), however, is associated with a greater risk of erectile dysfunction (ED) and urinary incontinence (UI).

In an observational study using Surveillance, Epidemiology and End Results (SEER)-Medicare data, Thomas L. Jang, MD, MPH, of Rutgers Cancer Institute of New Jersey, and colleagues compared survival outcomes associated with the 2 treatments among 13,856 men aged 65 years or older diagnosed with locally or regionally advanced PCa.

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At a median follow-up of 14.6 years, 2189 deaths occurred. Of these, 702 were PCa-related.

Regardless of tumor stage or Gleason score, the adjusted 10-year PCa-specific survival and 10-year overall survival (OS) rates were significantly higher with RP plus XRT compared with XRT plus ADT, Dr Jang’s team reported online ahead of print in Cancer. For example, among patients with T3a-bN0-XM0 cancer, the adjusted 10-year PCa-specific survival was 88.9% in the RP-XRT group compared with 74.2% in the RT-ADT group. The adjusted 10-year OS rates were 64.2% and 48.3%, respectively. The RT-XRT group had a significantly higher rate of ED (28% vs 20%) and UI (49% vs 19%).

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The investigators stated that their findings should be interpreted within the limitations of an observational study design. “Because our patients were not randomized, the 2 treatment groups may have differed in measured and unmeasured ways that are associated with differences in survival despite our best efforts to rigorously adjust for confounders,” they noted.

Another limitation was reliance on administrative claims, which are for billing purposes, they explained. Key information that may influence outcomes, such as radiation dosage or whether nerve-sparing was performed during RP, is not captured precisely.


Jang TL, Patel N, Faiena I, et al. Comparative effectiveness of radical prostatectomy with adjuvant radiotherapy versus radiotherapy plus androgen deprivation therapy for men with advanced prostate cancer. Cancer. 2018; published online ahead of print.