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Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies
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Radiotherapy- Versus Surgery-based Treatment Strategy in High-risk Prostate Cancer.

Soumyajit Roy1, Yilun Sun2, James A Eastham3

  • 1Department of Radiation Oncology, Rush University Medical Center, Chicago, IL, USA; Department of Radiation Oncology, University Hospitals - Seidman Cancer Center, Cleveland, OH, USA.

European Urology Oncology
|July 19, 2025
PubMed
Summary
This summary is machine-generated.

For high-risk prostate cancer, radiotherapy-based treatment significantly reduces distant metastasis compared to radical prostatectomy. The risk of death after metastasis was similar between the two treatment strategies.

Keywords:
Distant metastasisHigh-risk prostate cancerRadiation therapyRadical prostatectomy

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Area of Science:

  • Oncology
  • Radiation Oncology
  • Urologic Oncology

Background:

  • Optimal management for high-risk prostate cancer remains unclear.
  • Individual patient data from two North American cooperative group phase 3 randomized controlled trials (RCTs) were utilized.
  • Comparison of radiotherapy-based versus radical prostatectomy (RP)-based treatment strategies for high-risk prostate cancer patients.

Purpose of the Study:

  • To compare the outcomes of high-risk prostate cancer patients treated with radiotherapy-based and RP-based strategies.
  • To evaluate the cumulative incidence of distant metastasis as a primary endpoint.
  • To consider death as a competing event using inverse probability of treatment weighting (IPTW).

Main Methods:

  • Data from NRG/RTOG 0521 (radiotherapy) and CALGB 90203 (surgery) trials were analyzed.
  • Patients received radiotherapy plus androgen deprivation therapy (ADT) ± docetaxel, or RP with postoperative therapy ± neoadjuvant docetaxel and ADT.
  • IPTW was used to compare the cumulative incidence of distant metastasis.

Main Results:

  • 1290 patients were included with similar follow-up durations.
  • Patients undergoing surgery generally had more favorable prognostic features and were younger.
  • After IPTW, radiotherapy-based treatment showed a significantly lower 8-year cumulative incidence of distant metastasis (15% vs 22%; adjusted sHR 0.58; p=0.001).

Conclusions:

  • Radiotherapy-based treatment significantly lowers the incidence of distant metastasis in high-risk prostate cancer patients compared to RP-based treatment.
  • The risk of death following distant metastasis was comparable between the radiotherapy and RP groups.
  • These findings suggest radiotherapy-based strategies may offer improved distant control for high-risk prostate cancer.