Multimodality Care Optimal for Treating Aggressive Prostate Cancer

Guideline-concordant multimodal therapy is the optimal management strategy for high-risk prostate cancer patients, according to a study published in JAMA Network Open.

In this retrospective cohort study, the investigators analyzed approximately 6,000 men with high-risk prostate cancer and at least one adverse clinicopathologic feature treated between 2000 and 2014. The study exposures were radical prostatectomy (RP), external beam radiotherapy (EBRT) with androgen deprivation therapy (ADT), or EBRT plus brachytherapy boost (BT) with ADT. Guideline-concordant multimodal treatment was defined in the study as RP with appropriate use of multimodal therapy (optimal RP), EBRT with at least 2 years of ADT (optimal EBRT), or EBRT with BT with at least 1 year ADT (optimal EBRT with BT).

The primary outcome was stipulated as prostate cancer–specific mortality; distant metastasis was the secondary endpoint. Data analysis took place in November 2020.

According to the results, compared with RP, treatment with EBRT with BT or with EBRT alone was correlated with significantly improved prostate cancer–specific mortality; the researchers observed was no difference in prostate cancer–specific mortality between EBRT with BT and EBRT alone.

No significant differences in prostate cancer–specific mortality were found across treatment cohorts among patients who received guideline-concordant multimodality treatment. However, the researchers noted, treatment with EBRT alone or EBRT with BT was consistently associated with lower rates of distant metastasis compared with treatment with RP.

The study did have limitations. Firstly, the data was retrospective in nature, and attempts to minimize bias using statistical techniques, such as propensity score adjustments and site-centered covariates, are unable to eliminate biases. Secondly, the investigators noted, while definitions of optimal therapy were evidence-based, there is no universal agreement on how these definitions were reached.


These findings suggest that among patients with high-risk prostate cancer and additional unfavorable clinicopathologic features receiving guideline-concordant multimodal therapy, prostate cancer–specific mortality outcomes were equivalent among those treated with RP, EBRT, and EBRT with BT, although distant metastasis outcomes were more favorable among patients treated with EBRT and EBRT with BT,” the researchers concluded.

“Optimal multimodality treatment is critical for improving outcomes in patients with high-risk prostate cancer.”