PV QA 1 - Poster Viewing Q&A 1
Purpose/Objective(s): The treatment of prostate cancer, weather with prostatectomy, radiation therapy, or active surveillance varies based on risk factors including Gleason score (GS), PSA value and T staging. There is controversy regarding the impact of age on treatment modality choice for those with locally advanced prostate cancer despite the current risk stratification. The aim of this study is to compare survival outcomes in young men with locally advanced prostate cancer receiving either prostatectomy alone, external beam radiation (EBRT) alone, EBRT and brachytherapy (BT), or BT alone.
Materials/Methods: Patients with locally advanced prostate cancer (cN0M0) treated from 2004 to 2014 were analyzed by treatment modality, either prostatectomy alone, EBRT, EBRT+BT, or BT alone. Overall survival (OS) rates were compared using Kaplan-Meier method and log-rank test.
Results: 385,836 cases of invasive prostate cancer in men ≥18 years old and ≤60 without metastasis were reported in the NCDB from 2004-2014. 128,399 cases are being analyzed after excluding patients with histologies other than adenocarcinoma, undocumented PSA or GS, T0 disease, nodal or metastatic disease, history of chemotherapy, those that received neither surgery nor radiation or received both surgery and radiation, and cases in which treatment modality was unknown. Patients that received doses of radiation outside of the ranges of 40-50.40Gy or 75.60-81Gy were excluded. Patients were analyzed based on risk stratification derived from T stage, PSA and GS. Low-risk group represented 35.4 %, while intermediate- and high-risk groups were 39.9 and 19.1 % respectively. For all patients irrespective of subgroup, those receiving prostatectomy had a greater 10-year OS compared to those receiving radiation therapy of any type (81.5% vs. 87.91, p<0.0001). However for low-risk patients, BT had greater 10-year OS compared to prostatectomy (93.0% vs. 91.7%, p< 0.001). For intermediate-risk patients, combined EBRT+BT had a higher 10-year OS compared to prostatectomy (91.43% vs. 85.76%, p<.0001). In the high-risk subgroup, BT had similar 10-year OS compared to prostatectomy (84.34% vs. 86.33%, p=0.1158).
Conclusion: Based on this NCDB analysis, BT as monotherapy in low-risk and along with EBRT in intermediate-risk improves 10-year OS compared to prostatectomy alone in young men (≤60).
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