High-grade prostate adenocarcinoma (Gleason Score ≥8): survival and disease control following radical prostatectomy versus radiotherapy plus long-course hormone therapy
Tóm tắt
The optimal primary intervention for treatment of clinically localized high-grade prostate cancer remains to be identified. The present investigation compares disease control in patients treated with primary radical prostatectomy (RP) versus radiotherapy (RT). Eligible patients were identified by Gleason 8–10 prostate adenocarcinoma at biopsy between 2003 and 2010, treated with either primary RP or RT. Patients with PSA ≥30 or clinically evident seminal vesicle or lymph node involvement at diagnosis or follow-up ≤24 months were excluded. Contemporary definitions of disease recurrence were employed. Between 2003 and 2010, 116 patients with Gleason 8–10 prostate cancer were identified, of whom 87 were eligible for the present analysis (41 RP, 46 RT + HT). Excepting age (RP younger), demographic factors were similar between groups. Three RP patients received immediate post-operative RT. All but one RT patient received hormone therapy (hereafter, RT + HT; median 27.5 months; 85 % >12 months, 30 % >30 months). At a median follow-up of 54 months (similar between groups), 39 patients had experienced disease recurrence (30 RP, 9 RT + HT). Estimated 5-year disease control was superior for RT + HT (21 vs. 74 %; p < 0.001), without difference in cancer-specific survival (89 vs. 95 %; p = 0.844). RT + HT-based treatment of high-grade prostate cancers demonstrates superior disease control compared with RP, without impact on disease-specific survival at 5 years. Further investigation is warranted in order to identify subset patient populations who may experience differential benefit from each approach.
Tài liệu tham khảo
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