Efficacy of Definitive External-beam Radiotherapy Versus Radical Prostatectomy on Clinically Localized High-risk Prostate Cancer Patients: A Retrospective Study

Objective To retrospectively compare the efficacy between definitive external-beam radiotherapy (ExRT) and radical prostatectomy(RP) on patients with localized high-risk prostate cancer (PCa).

Methods We retrospectively studied 150 patients with high-risk PCa(T2b-T4N0M0) who underwent definitive ExRT or RP. The inclusion criteria for high-risk PCa were PSA≥20 ng/ml or above cT3 or GS≥8. The primary end point was biochemical failure free survival(BFFS), and the secondary end point was distant metastasis free survival(DMFS), cancer-specific survival(CSS) and overall survival(OS).

Results A total of 88 patients underwent definitive ExRT and androgen deprivation therapy(ADT), and the remaining 62 patients underwent RP and pelvic lymphadenectomy(PLND). The median age and follow-up time were statistically significant between ExRT and RP groups(P < 0.05). The biochemical failure(BF) rate in ExRT group was significantly lower than that in RP group(P < 0.001), while BFFS was significantly increased(P < 0.001). The DMFS, CSS and OS were not significantly different between the two groups.

Conclusion BF rate after definitive ExRT in patients with localized high-risk PCa are significantly lower than those undergoing RP, while BFFS is significantly increased.