Radiotherapy Without Surgery May Be Feasible in High-Grade Prostate Cancer - Journal of Clinical Pathways

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Treatment with radical prostatectomy, adjuvant external beam radiotherapy, and androgen deprivation therapy (MaxRP) or external beam radiotherapy, brachytherapy, and androgen deprivation therapy (MaxRT) provide comparable survival outcomes for men with Gleason score 9-10 prostate cancer.

Limited data exist regarding how treatment with MaxRP compared with MaxRT decreases the risk of disease-specific and all-cause mortality in high-grade prostate cancer.

Anthony V D’Amico, MD, PhD, department of radiation oncology, Dana-Farber Cancer Institute (Boston, MA), and colleagues conducted a study to investigate the association of these surgical and radiation approaches with mortality in patients with Gleason score 9-10 prostate cancer. A total of 639 men with clinical T1-4, N0M0 biopsy Gleason score 9-10 prostate cancer were included in the study, 80 of whom were treated with MaxRT and 559 of whom were treated with MaxRP.

Researchers assessed for treatment propensity score-adjusted risk of prostate cancer-specific and all-cause mortality as well as the likelihood of equivalence of these risks between treatment by utilizing a plausibility index.

Results of the study were published in JAMA Oncology (online November 15, 2018; doi:10.1001/jamaoncol.2018.4836).

After a median follow-up of 5.51 years for patients in the MaxRT cohort and 4.78 years for patients in the MaxRP, researchers reported that 161 patients had died, 65.8% of whom (n – 106) due to prostate cancer.

Importantly, Dr D’Amico and colleagues reported that there was no significant difference in the risk of prostate cancer-specific mortality (adjusted HR, 1.33; 95% CI, 0.49-3.64; P = .58) and all-cause mortality (adjusted HR, 0.80; 95% CI, 0.36-1.81; P = .60) when comparing patients who underwent MaxRP vs MaxRT.

Plausibility indexes for equivalence were 76.75% for the end point of the risk of prostate cancer-specific mortality and 77.97% for the end point of the risk of all-cause mortality.

Researchers concluded that it is “plausible” that treatment with MaxRP or MaxRT for men with Gleason score 9-10 prostate cancer provides equivalent survival outcomes. However, Dr D’Amico cautions that this data cannot substitute for a randomized trial and there are no current trials that stratify by Gleason score 9-10.

“Therefore, this data that we have presented in this study stands as the only data really that will exist now and will exist in the future…on this very important subset, which makes up most of prostate cancer death,” he said in an audio interview that accompanies the study.—Zachary Bessette



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