Assessing Outcomes Following Radical Prostatectomy for Patients with Gleason 9 and 10 Prostate Cancer

A study sought to discern the optimal upfront treatment modality for patients with nonmetastatic Gleason Score 9 and 10 prostate cancer (GS 9-10 PCa). The findings were published in journal Cancer Medicine.

This retrospective cohort study comprised of 1,220 veterans from the Veterans Health Administration (VHA) with GS 9-10 PCa treated with radical prostatectomy (RP, n = 335) or external beam radiation therapy with androgen deprivation therapy (EBRT+ADT, n = 885) from 2000 to 2010. Outcomes of interest were defined as overall survival (OS), distant metastasis-free survival (DMFS), and salvage/adjuvant therapy-free survival (SAFS). The median follow up was ~10 years.

The results of the analysis demonstrated that patients treated with RP had superior 10-year OS (70.8% [RP] vs. 61.2% [EBRT+ADT], p < 0.001), while 10-year DMFS rates were similar between RP (76.7%) and EBRT+ADT (81.0%), and 10-year SAFS rates were lower for RP vs EBRT + ADT (35.2% [RP] vs. 75.2% [EBRT+ADT], p < 0.001). They noted that the rate of receiving salvage ADT was higher with upfront RP (51.9% vs. 26.1%, p < 0.001), despite receipt of adjuvant/salvage EBRT in 41.8% of RP patients. In patients treated with RP, while there were no differences in outcomes by race, the study did find higher survival rates were noted among Black patients treated with EBRT+ADT compared with White patients.

“This analysis demonstrated higher 10-year OS rates among men treated with upfront RP versus EBRT+ADT, though missing confounders and similar DMFS rates suggest the long-term cause-specific OS rates may be similar. We also highlight real-world outcomes of a diverse patient population in the VHA and improved outcomes for Black patients receiving EBRT+ADT,” the researchers concluded.