Multimodal Treatment and Mortality Outcomes in High-Risk Prostate Cancer
Posted: Tuesday, September 7, 2021
According to research presented in JAMA Network Open, patients with high-risk prostate cancer and adverse clinicopathologic features who received guideline-concordant multimodal therapy may experience improved survival outcomes. Derya Tilki, MD, of the University Hospital Hamburg-Eppendorf in Germany, and colleagues defined guideline-concordant multimodal treatment as optimal radical prostatectomy, which included the appropriate use of multimodal therapy; optimal external-beam radiotherapy, which included 2 or more years of androgen-deprivation therapy (ADT); or optimal external-beam radiotherapy with a brachytherapy boost, which included 1 or more years of ADT.
The retrospective study included 6,004 men, with an average age of 66.4 years. Patients who received external-beam radiotherapy with (16.6%; n = 999) or without a brachytherapy boost (30.5%; n = 1,830) experienced substantially better disease-specific mortality than did patients who underwent radical prostatectomy (52.9%; n = 3,175; subdistribution hazard ratio [sHR] = 0.78, [95% confidence interval (CI) =, 0.63–0.97]; P = .03 and sHR = 0.70 [95% CI = 0.53–0.92]; P = .01, respectively). The addition of a brachytherapy boost to external-beam radiotherapy did not appear to affect disease-specific mortality.
Patients who underwent multimodality therapy (n = 2,940) experienced similar prostate cancer–specific mortality results as those who did not (eg, optimal external-beam radiotherapy vs. optimal radical prostatectomy: sHR = 0.76 [95% CI = 0.52–1.09]; P = .14). Notably, treatment with external-beam radiotherapy with or without a brachytherapy boost was found to be associated with fewer instances of distant metastasis than was treatment with radical prostatectomy (eg, external-beam radiotherapy alone vs. radical prostatectomy: sHR = 0.50 [95% CI = 0.44–0.58]; P < .001).
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.