Oncologic Outcomes of Radical Prostatectomy and High-Dose Intensity-Modulated Radiotherapy with Androgen-Deprivation Therapy for Relatively Young Patients with Unfavorable Intermediate-Risk Prostate Adenocarcinoma
by
and
Szu-Yuan Wu
1,2,3,4,5,6,7,†, 
Shyh-Chyi Chang
8,9,†,
Chang-I Chen
10,11 and
Chung-Chien Huang
11,* 1
Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung 413, Taiwan
2
Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 256, Taiwan
3
Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 256, Taiwan
4
Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung 413, Taiwan
5
Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 256, Taiwan
6
Graduate Institute of Business Administration, Fu Jen Catholic University, Taipei 242062, Taiwan
7
Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei 110, Taiwan
8
Department of Urology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 256, Taiwan
9
Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei 11221, Taiwan
10
International Ph.D. Program in Biotech and Healthcare Management, Taipei Medical University, Taipei 110, Taiwan
11
Department of Health Care Administration, College of Management, Taipei Medical University, Taipei 110, Taiwan
*
Author to whom correspondence should be addressed.
†
These authors have contributed equally to this study.
Cancers 2021, 13(7), 1517; https://doi.org/10.3390/cancers13071517
Submission received: 8 February 2021
/
Revised: 21 March 2021
/
Accepted: 23 March 2021
/
Published: 25 March 2021
(This article belongs to the Special Issue Diagnosis and Treatment of Prostate Adenocarcinoma)
Simple Summary
Scarce reports have evaluated oncologic outcomes in relatively young men with unfavorable intermediate-risk prostate cancer (UIR-PC) receiving radical prostatectomy (RP) or high-dose intensity-modulated radiotherapy (IMRT). After a literature review, we present the leading and largest head-to-head propensity score-matched study to examine all-cause death, biochemical failure (BF), locoregional recurrence (LRR), and distant metastasis (DM) in relatively young men with UIR-PC undergoing RP or high-dose IMRT. After adjustment for confounders, RP was found to be superior to high-dose IMRT in terms of the patients’ overall survival, BF, LRR, and DM.
Abstract
Purpose: To estimate the oncologic outcomes of radical prostatectomy (RP) and high-dose intensity-modulated radiotherapy (IMRT) with short-term androgen-deprivation therapy (ADT) in relatively young men with unfavorable intermediate-risk prostate cancer, as defined by the National Comprehensive Cancer Network (NCCN-UIR-PC). Patients and Methods: We enrolled relatively young men (≤65 years) from the Taiwan Cancer Registry who had been diagnosed as having NCCN-UIR-PC and who had received RP or high-dose IMRT (at least ≥72 Gy) with short-term ADT (4–6 months). After propensity score matching of the confounders, Cox proportional regression was used to model the time from the index date (i.e., date of diagnosis) to all-cause death, biochemical failure (BF), locoregional recurrence (LRR), and distant metastasis (DM). Results: The corresponding adjusted hazard ratios (95% confidence intervals) of the risk of all-cause death, BF, LRR, and DM were 2.76 (1.36–5.60, p = 0.0050), 2.74 (1.72–4.84, p < 0.0001), 1.28 (1.09–1.90, p = 0.0324), and 2.11 (1.40–4.88, p = 0.0052), respectively. Conclusions: RP is superior to high-dose IMRT with short-term ADT in terms of oncologic outcomes for relatively young men with UIR-PC.
