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Radical Prostatectomy Versus Radiotherapy for Prostate Cancer: Stage-, Age-, and Frailty-Specific Cancer-Control

Mike Wenzel1, Katrin Burdenski, Nikolaos Tselis

  • 1Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany; University Cancer Center Frankfurt (UCT), Frankfurt am Main, Germany; Department of Radiation Oncology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany; Department of Hematology/Oncology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany; Department of Pathology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany; Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.

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Radical prostatectomy (RP) and radiotherapy (RT) offer comparable outcomes for prostate cancer patients when adjusted for patient and tumor characteristics. This study found no significant differences in metastasis-free, cancer-specific, or overall survival between the two treatments.

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Area of Science:

  • Oncology
  • Urology
  • Medical Statistics

Background:

  • Radical prostatectomy (RP) and radiotherapy (RT) are standard treatments for prostate cancer.
  • Existing comparative data between RP and RT are limited.

Purpose of the Study:

  • To compare metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS) between prostate cancer patients treated with RP versus RT.
  • To conduct stage-, age-, and frailty-specific sensitivity analyses.

Main Methods:

  • Utilized data from a university cancer center database (2014-2024).
  • Included 2685 prostate cancer patients (1999 RP, 686 RT).
  • Performed multivariable Cox regression and 2:1 propensity-score-matched analyses.

Main Results:

  • Univariate analyses showed mixed results (RT favored MFS, RP favored OS).
  • Adjusted analyses (Cox regression, propensity-score matching) revealed no significant differences in MFS, CSS, or OS between RP and RT.
  • RP patients were younger and had higher-risk disease characteristics compared to RT patients.

Conclusions:

  • RP and RT demonstrate equally effective cancer control for prostate cancer when adjusted for patient and tumor characteristics.
  • Current practice trends show higher rates of RP for high-risk prostate cancer and unfavorable stages.