Survival benefit of radical prostatectomy for non-metastatic prostate cancer: a propensity score-matched SEER...

Prostate cancer exhibits high incidence among males, yet the clinical utility of surgical intervention for non-metastatic disease remains controversial.

We extracted 290,749 cases from the SEER database (2010-2015) and categorized patients into a curative-directed surgery (CDS) group and a non-CDS group (surgery recommended but not performed). Propensity score matching (PSM) was applied to balance baseline characteristics. Survival analysis was conducted using Kaplan-Meier methods with stratified cumulative hazard curves, followed by multivariable Cox proportional hazards regression to estimate hazard ratios (HRs). Model selection was performed using the corrected Akaike Information Criterion (AICc).

After propensity score matching (PSM), each group consisted of 8,330 patients. The cumulative risk curves indicated no significant survival benefit in the CDS group compared to the non-CDS group (p = 0.34). Stratified analysis revealed age-dependent risk escalation, particularly pronounced in patients over 74 years old. Surgery was found to reduce the risk in stage T2 patients but had no such effect on stage T1 patients. Increased PSA levels and Gleason scores significantly worsened prognosis (p < 0.0001). Multivariate Cox regression analysis demonstrated that Gleason score is a critical factor influencing mortality risk, with high-risk Gleason scores (8-10) conferring a 6.31-fold (95% CI 6.23-8.58) increase in risk compared to low-risk scores (≤ 6), consistent with the trend observed in the cumulative risk curves.

For non-metastatic prostate cancer, surgical intervention may not confer a survival benefit, underscoring the need for cautious clinical decision-making. These findings warrant validation through prospective studies to elucidate the underlying mechanisms and refine treatment guidelines.