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. 2022 Jan;82(1):120-131.
doi: 10.1002/pros.24253. Epub 2021 Oct 18.

Cancer-specific survival after radical prostatectomy versus external beam radiotherapy in high-risk and very high-risk African American prostate cancer patients

Benedikt Hoeh  1   2 , Christoph Würnschimmel  2   3 , Rocco S Flammia  2   4 , Benedikt Horlemann  2 , Gabriele Sorce  2   5 , Francesco Chierigo  2   6 , Zhe Tian  2 , Fred Saad  2 , Markus Graefen  3 , Michele Gallucci  4 , Alberto Briganti  5 , Carlo Terrone  6 , Shahrokh F Shariat  7   8   9   10   11   12 , Luis A Kluth  1 , Philipp Mandel  1 , Felix K H Chun  1 , Pierre I Karakiewicz  2
Affiliations

Cancer-specific survival after radical prostatectomy versus external beam radiotherapy in high-risk and very high-risk African American prostate cancer patients

Benedikt Hoeh et al. Prostate. 2022 Jan.

Abstract

Background: To test for differences in cancer-specific mortality (CSM) rates between radical prostatectomy (RP) vs external beam radiotherapy (EBRT) in National Comprehensive Cancer Network (NCCN) high-risk African American patients, as well as Johns Hopkins University (JHU) high-risk and very high-risk patients.

Materials and methods: Within the Surveillance, Epidemiology, and End Results database (2010-2016), we identified 4165 NCCN high-risk patients, of whom 1944 (46.7%) and 2221 (53.3%) patients qualified for JHU high-risk or very high-risk definitions. Of all 4165 patients, 1390 (33.5%) were treated with RP versus 2775 (66.6%) with EBRT. Cumulative incidence plots and competing risks regression models addressed CSM before and after 1:1 propensity score matching between RP and EBRT NCCN high-risk patients. Subsequently, analyses were repeated separately in JHU high-risk and very high-risk subgroups. Finally, all analyses were repeated after landmark analyses were applied.

Results: In the NCCN high-risk cohort, 5-year CSM rates for RP versus EBRT were 2.4 versus 5.2%, yielding a multivariable hazard ratio of 0.50 (95% confidence interval [CI] 0.30-0.84, p = 0.009) favoring RP. In JHU very high-risk patients 5-year CSM rates for RP versus EBRT were 3.7 versus 8.4%, respectively, yielding a multivariable hazard ratio of 0.51 (95% CI: 0.28-0.95, p = 0.03) favoring RP. Conversely, in JHU high-risk patients, no significant CSM difference was recorded between RP vs EBRT (5-year CSM rates: 1.3 vs 1.3%; multivariable hazard ratio: 0.55, 95% CI: 0.16-1.90, p = 0.3). Observations were confirmed in propensity score-matched and landmark analyses adjusted cohorts.

Conclusions: In JHU very high-risk African American patients, RP may hold a CSM advantage over EBRT, but not in JHU high-risk African American patients.

Keywords: external beam radiotherapy; high-risk; prostate cancer; radical prostatectomy; very high-risk.

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References

REFERENCES

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