Radical prostatectomy with adjuvant external beam radiotherapy (EBRT) plus androgen deprivation therapy (ADT) for biopsy Gleason score 9–10 prostate cancer offers survival outcomes similar to those of a triple combination of EBRT, brachytherapy, and ADT, according to a new study.

The study, led by Anthony V. D’Amico, MD, PhD, of Dana-Farber Cancer Institute in Boston,  included 639 men, of whom 559 underwent radical prostatectomy (RT) plus adjuvant EBRT or ADT, or both (MaxRP), and 80 who received the EBRT-brachytherapy-ADT combination (MaxRT). The median follow-up was 4.78 years for the RP patients and 5.51 years for the MaxRT group. A total of 161 patients died, 106 (65.8%) from prostate cancer.

When they compared the MaxRP and MaxRT group, Dr D’Amico and colleagues found no significant differences in prostate-cancer specific mortality (PCSM) and all-cause mortality (ACM), in adjusted analyses, according to results published in JAMA Oncology.

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The investigators said their findings are important because, to their knowledge, there are no ongoing or planned randomized equivalence trials comparing PCSM and ACM after MaxRP vs MaxRT for men with biopsy Gleason score 9–10 PCa. “They [the findings] provide the only available evidence to date to support that it is plausible that treatment with Max RP or MaxRT can lead to equivalent risk of PCSM and ACM in men with biopsy Gleason score 9–10 prostate cancer,” they concluded.


Tilki D, Chen MH, Wu J, et al. Surgery vs radiotherapy in the management of biopsy Gleason score 9–10 prostate cancer and the risk of mortality. JAMA Oncol. 2018; published online ahead of print.