Comparison of Clinical Outcomes of Radical Prostatectomy versus IMRT with Long-Term Hormone Therapy for Relatively Young Patients with High- to Very High-Risk Localized Prostate Cancer
That intensity-modulated radiotherapy (IMRT) plus antiandrogen therapy (IMRT-ADT) and radical prostatectomy (RP) are the definitive optimal treatments for relatively young patients (aged ≤ 65 years) with high- or very high-risk localized prostate cancer (HR/VHR-LPC), but remains controversial. We co...
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| Format: | Article |
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MDPI AG
2021-11-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/13/23/5986 |
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| author | Hung-Jen Shih Shyh-Chyi Chang Chia-Hao Hsu Yi-Chu Lin Chu-Hsuan Hung Szu-Yuan Wu |
| author_facet | Hung-Jen Shih Shyh-Chyi Chang Chia-Hao Hsu Yi-Chu Lin Chu-Hsuan Hung Szu-Yuan Wu |
| author_sort | Hung-Jen Shih |
| collection | DOAJ |
| description | That intensity-modulated radiotherapy (IMRT) plus antiandrogen therapy (IMRT-ADT) and radical prostatectomy (RP) are the definitive optimal treatments for relatively young patients (aged ≤ 65 years) with high- or very high-risk localized prostate cancer (HR/VHR-LPC), but remains controversial. We conducted a national population-based cohort study by using propensity score matching (PSM) to evaluate the clinical outcomes of RP and IMRT-ADT in relatively young patients with HR/VHR-LPC. <i>Methods</i>: We used the Taiwan Cancer Registry database to evaluate clinical outcomes in relatively young (aged ≤ 65 years) patients with HR/VHR-LPC, as defined by the National Comprehensive Cancer Network risk strata. The patients had received RP or IMRT-ADT (high-dose, ≥72 Gy plus long-term, 1.5–3 years, ADT). Head-to-head PSM was used to balance potential confounders. A Cox proportional hazards regression model was used to analyze oncologic outcomes. <i>Results</i>: High-dose IMRT-ADT had a higher risk of biochemical failure (adjusted hazard ratio [aHR] = 2.03, 95% confidence interval [CI] 1.56–2.65, <i>p</i> < 0.0001) compared with RP; IMRT-ADT did not have an increased risk of all-cause death (aHR = 1.2, 95% CI 0.65–2.24, <i>p</i> = 0.564), locoregional recurrence (aHR = 0.88, 95% CI 0.67–1.06, <i>p</i> = 0.3524), or distant metastasis (aHR = 1.03, 95% CI 0.56–1.9, <i>p</i> = 0.9176) compared with RP. <i>Conclusion</i>: In relatively young patients with HR/VHR-LPC, RP and IMRT-ADT yielded similar oncologic outcomes and RP reduced the risk of biochemical failure compared with IMRT-ADT. |
| first_indexed | 2024-03-10T04:56:02Z |
| format | Article |
| id | doaj.art-3c0d39bf598d47e6baa3cb953cdb8804 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-10T04:56:02Z |
| publishDate | 2021-11-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-3c0d39bf598d47e6baa3cb953cdb88042023-11-23T02:12:38ZengMDPI AGCancers2072-66942021-11-011323598610.3390/cancers13235986Comparison of Clinical Outcomes of Radical Prostatectomy versus IMRT with Long-Term Hormone Therapy for Relatively Young Patients with High- to Very High-Risk Localized Prostate CancerHung-Jen Shih0Shyh-Chyi Chang1Chia-Hao Hsu2Yi-Chu Lin3Chu-Hsuan Hung4Szu-Yuan Wu5Division of Urology, Department of Surgery, Changhua Christian Hospital, Changhua 500, TaiwanDepartment of Urology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 265, TaiwanDepartment of Urology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 265, TaiwanDepartment of Urology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 265, TaiwanDepartment of Urology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 265, TaiwanDepartment of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung 413, TaiwanThat intensity-modulated radiotherapy (IMRT) plus antiandrogen therapy (IMRT-ADT) and radical prostatectomy (RP) are the definitive optimal treatments for relatively young patients (aged ≤ 65 years) with high- or very high-risk localized prostate cancer (HR/VHR-LPC), but remains controversial. We conducted a national population-based cohort study by using propensity score matching (PSM) to evaluate the clinical outcomes of RP and IMRT-ADT in relatively young patients with HR/VHR-LPC. <i>Methods</i>: We used the Taiwan Cancer Registry database to evaluate clinical outcomes in relatively young (aged ≤ 65 years) patients with HR/VHR-LPC, as defined by the National Comprehensive Cancer Network risk strata. The patients had received RP or IMRT-ADT (high-dose, ≥72 Gy plus long-term, 1.5–3 years, ADT). Head-to-head PSM was used to balance potential confounders. A Cox proportional hazards regression model was used to analyze oncologic outcomes. <i>Results</i>: High-dose IMRT-ADT had a higher risk of biochemical failure (adjusted hazard ratio [aHR] = 2.03, 95% confidence interval [CI] 1.56–2.65, <i>p</i> < 0.0001) compared with RP; IMRT-ADT did not have an increased risk of all-cause death (aHR = 1.2, 95% CI 0.65–2.24, <i>p</i> = 0.564), locoregional recurrence (aHR = 0.88, 95% CI 0.67–1.06, <i>p</i> = 0.3524), or distant metastasis (aHR = 1.03, 95% CI 0.56–1.9, <i>p</i> = 0.9176) compared with RP. <i>Conclusion</i>: In relatively young patients with HR/VHR-LPC, RP and IMRT-ADT yielded similar oncologic outcomes and RP reduced the risk of biochemical failure compared with IMRT-ADT.https://www.mdpi.com/2072-6694/13/23/5986prostate cancerradical prostatectomyintensity-modulated radiotherapyyoung men |
| spellingShingle | Hung-Jen Shih Shyh-Chyi Chang Chia-Hao Hsu Yi-Chu Lin Chu-Hsuan Hung Szu-Yuan Wu Comparison of Clinical Outcomes of Radical Prostatectomy versus IMRT with Long-Term Hormone Therapy for Relatively Young Patients with High- to Very High-Risk Localized Prostate Cancer Cancers prostate cancer radical prostatectomy intensity-modulated radiotherapy young men |
| title | Comparison of Clinical Outcomes of Radical Prostatectomy versus IMRT with Long-Term Hormone Therapy for Relatively Young Patients with High- to Very High-Risk Localized Prostate Cancer |
| title_full | Comparison of Clinical Outcomes of Radical Prostatectomy versus IMRT with Long-Term Hormone Therapy for Relatively Young Patients with High- to Very High-Risk Localized Prostate Cancer |
| title_fullStr | Comparison of Clinical Outcomes of Radical Prostatectomy versus IMRT with Long-Term Hormone Therapy for Relatively Young Patients with High- to Very High-Risk Localized Prostate Cancer |
| title_full_unstemmed | Comparison of Clinical Outcomes of Radical Prostatectomy versus IMRT with Long-Term Hormone Therapy for Relatively Young Patients with High- to Very High-Risk Localized Prostate Cancer |
| title_short | Comparison of Clinical Outcomes of Radical Prostatectomy versus IMRT with Long-Term Hormone Therapy for Relatively Young Patients with High- to Very High-Risk Localized Prostate Cancer |
| title_sort | comparison of clinical outcomes of radical prostatectomy versus imrt with long term hormone therapy for relatively young patients with high to very high risk localized prostate cancer |
| topic | prostate cancer radical prostatectomy intensity-modulated radiotherapy young men |
| url | https://www.mdpi.com/2072-6694/13/23/5986 |
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