RICHMOND, VA — Clinicians haven’t had information on the optimal upfront treatment modality for patients with non-metastatic Gleason Score 9 and 10 prostate cancer (GS 9-10 PCa).
To remedy that, researchers from the Hunter Holmes McGuire VAMC and Virginia Commonwealth University, both in Richmond, VA, conducted a retrospective cohort study of patients in the VHA with GS 9-10 PCa treated with radical prostatectomy (RP) or external beam radiation therapy with androgen deprivation therapy (EBRT+ADT) from January 2000 to December 2010.
For the study, which also involved VA researchers from Durham, NC, and Los Angeles, outcomes of interest included overall survival (OS), distant metastasis-free survival (DMFS) and salvage/adjuvant therapy-free survival (SAFS), as assessed by Kaplan-Meier analysis. Results were published in Cancer Medicine.1
The study team identified 1,220 veterans with GS 9-10 PCa. Of those, 335 were treated with RP, and 885 were treated with EBRT+ADT. After a median follow-up of 9.9 years, propensity score-matched analyses indicated that RP had superior 10-year overall survival (70.8% [RP] vs. 61.2% [EBRT+ADT], p < 0.001), Researchers noted that 10-year DMFS rates were similar between RP (76.7%) and EBRT+ADT (81.0%) and 10-year SAFS rates were lower for RP vs EBRT + ADT (35.2% [RP] vs. 75.2% [EBRT+ADT], p < 0.001).
“The receipt of salvage ADT was higher with upfront RP (51.9% vs. 26.1%, p < 0.001), despite receipt of adjuvant/salvage EBRT in 41.8% of RP patients,” the authors noted. “Among patients treated with RP, there were no differences in outcomes by race. However, higher survival rates were noted among Black patients treated with EBRT+ADT compared with white patients.”
The authors raised some questions about the results, however, pointing out, “This analysis demonstrated higher 10-year OS rates among men treated with upfront RP versus EBRT+ADT, though missing confounders and similar DMFS rates suggest the long-term cause-specific OS rates may be similar.”
They added that their findings “also highlight real-world outcomes of a diverse patient population in the VHA and improved outcomes for Black patients receiving EBRT+ADT.”
- Chao HH, Soni PD, Dahman B, Stilianoudakis SC, et. al. Outcomes following radical prostatectomy or external beam radiation for veterans with Gleason 9 and 10 prostate cancer. Cancer Med. 2022 Aug;11(15):2886-2895. doi: 10.1002/cam4.4656. Epub 2022 Mar 15. PMID: 35289111; PMCID: PMC9359878.