PV QA 1 - Poster Viewing Q&A 1
Purpose/Objective(s): We evaluated rates of biochemical control, prostate cancer-specific survival, and overall survival in a cohort of elderly men presenting with clinically localized high-risk prostate cancer (HRPCa) definitively treated with radical prostatectomy (RP) or combined external beam radiotherapy (EBRT) and androgen deprivation therapy (ADT) in a multi-center setting.
Materials/Methods: Men aged>70 who were definitively treated from 2008-2016 with either RP or combined EBRT+ADT for HRPCa were included in this study. All clinical data were queried from our IRB-approved tumor registry confirming presence of HRPCa as classified by biopsy gleason score (GS), initial prostate-specific antigen level (iPSA), and clinical tumor stage (T-stage). Survival was calculated from time of surgery or end of EBRT. Differences in baseline characteristics between treatment groups were identified using ANOVA and Chi-Square testing. Clinical predictors of study outcomes were identified through multivariate analysis (MVA). Kaplan-Meier curves were generated for each treatment group and survival differences identified by log rank testing.
Results: 469 men with a median age of 74 were included in this study. Median follow-up of EBRT+ADT and RP patients were 61 and 55 months, respectively. Comparison of baseline characteristics demonstrated that men who underwent EBRT+ADT presented with higher age, iPSA, and T-stage compared to men who underwent RP (Table 1). MVA demonstrated that higher iPSA (HR 1.02, p=.009), GS (HR=1.38, p=.027), and percent positive cores (HR=5.32, p<.001) were associated with inferior biochemical control. Higher iPSA (HR=1.23, p=.04) and GS (HR=3.16, p=.009) were associated with inferior prostate cancer-specific survival. Older age was associated with inferior overall survival (HR=1.06, p=.04). Patients who underwent EBRT+ADT had superior 5-year biochemical control compared to those who underwent RP (65% v. 46%, p<.001). EBRT+ADT patients had inferior overall survival compared to RP patients (79% v. 88%, p=.005), however no difference was seen with respect to prostate cancer-specific survival, (94.2% v. 94.5%, p=.39).
Conclusion: We observed that men treated with combined EBRT+ADT had inferior overall survival compared to men treated with RP—likely an impact of older median age in the EBRT+ADT group. Despite treating disease of higher iPSA and clinical T-stage, combined EBRT+ADT provided superior biochemical control and equivalent prostate cancer-specific survival compared to RP in elderly men with HRPCa. Table 1. Baseline characteristics of patients
|Median (+) Cores||43%||50%||.49|
|2a or 2b||51%||40%||-|
|9 or 10||30%||36%||-|
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