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Cancer-Specific Mortality in Rare Histological Subtypes of Prostate Cancer: Radical Prostatectomy Versus Radiation
Carolin Siech1,2, Mario de Angelis3,4,5, Letizia Maria Ippolita Jannello3,6,7
1Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada. siech@med.uni-frankfurt.de.
Annals of Surgical Oncology
|February 20, 2026
Summary
Radical prostatectomy (RP) shows lower cancer-specific mortality (CSM) than radiation therapy (RT) for acinar, ductal, and neuroendocrine prostate cancer subtypes. No significant differences in CSM were found between RP and RT for mucinous and signet ring cell prostate cancer.
Area of Science:
- Oncology
- Urology
- Cancer Research
Background:
- Cancer-specific mortality (CSM) rates for rare prostate cancer histological subtypes after radical prostatectomy (RP) versus radiation therapy (RT) are not well-established.
- Understanding treatment outcomes is crucial for guiding clinical decisions in these less common prostate cancer types.
Purpose of the Study:
- To compare cancer-specific mortality (CSM) rates between radical prostatectomy (RP) and radiation therapy (RT) in patients with rare prostate cancer histological subtypes.
- To identify which treatment modality offers better survival outcomes for specific rare prostate cancer subtypes.
Main Methods:
- Utilized the Surveillance, Epidemiology, and End Results (SEER) database (2004-2020) to identify patients with five rare prostate cancer subtypes.
- Employed Kaplan-Meier analyses and Cox regression models to assess cancer-specific mortality (CSM) and treatment efficacy.
Main Results:
- Radical prostatectomy (RP) was associated with significantly lower cancer-specific mortality (CSM) compared to radiation therapy (RT) in acinar, ductal, and neuroendocrine prostate cancer subtypes.
- No significant differences in CSM were observed between RP and RT for mucinous and signet ring cell prostate cancer subtypes.
- Five-year CSM rates varied significantly, with neuroendocrine carcinoma showing the highest mortality regardless of treatment.
Conclusions:
- Radiation therapy (RT) is associated with higher cancer-specific mortality (CSM) in acinar, ductal, and neuroendocrine prostate cancer compared to radical prostatectomy (RP).
- For mucinous and signet ring cell adenocarcinoma, radical prostatectomy (RP) and radiation therapy (RT) demonstrate comparable cancer-specific mortality (CSM) outcomes.
- Treatment decisions for rare prostate cancer subtypes should consider histological type to optimize survival outcomes.
