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Radical Prostatectomy Versus Radiation Therapy for Locally Advanced and Clinically Nodal Positive Prostate Cancer.

Mike Wenzel1, Katrin Burdenski2, Nikolaos Tselis3

  • 1Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany.

Clinical Genitourinary Cancer
|May 30, 2025
PubMed
Summary

Radical prostatectomy (RP) and radiation therapy (RT) show similar cancer control for advanced prostate cancer. Real-world data indicate comparable metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS) for both treatments in high-risk patients.

Keywords:
BrachytherapyEBRTN1RARPRadiotherapy

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Area of Science:

  • Oncology
  • Urology
  • Cancer Research

Background:

  • Radical prostatectomy (RP) and radiation therapy (RT) are standard treatments for advanced prostate cancer (aPCa).
  • Comparative data for aPCa treatments remain limited.

Purpose of the Study:

  • To compare outcomes of RP versus RT in patients with locally advanced prostate cancer (cT3-4) and clinically node-positive (cN1) disease.
  • To evaluate metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS).

Main Methods:

  • Retrospective analysis of patients treated between 2014 and 2024 from a University Cancer Center database.
  • Comparison of outcomes for cT3-4 and cN1 prostate cancer patients undergoing either RP or RT.
  • Multivariable adjustment for patient and tumor characteristics.

Main Results:

  • For cT3-4 patients, no significant differences in MFS, CSS, or OS were observed between RP and RT groups after multivariable adjustment.
  • For cN1 patients, initial univariable analysis suggested better MFS with RT, but multivariable analysis revealed no significant differences in MFS, CSS, or OS between RP and RT.
  • RP patients were generally younger with lower PSA levels and RT patients had higher rates of ISUP grade 4-5.

Conclusions:

  • Real-world evidence suggests RP and RT provide comparable cancer control outcomes for locally advanced and node-positive prostate cancer.
  • Both treatments demonstrate excellent cancer control in this high-risk patient cohort.
  • Adjusting for patient and tumor characteristics is crucial when comparing treatment efficacy.