Quick Take: Surgery vs Radiotherapy in the Management of Biopsy Gleason Score 9-10 Prostate Cancer and the Risk of Mortality

Several treatment regimens are available for prostate cancer with a Gleason score of 9 or 10. These include radical prostatectomy (RP) with adjuvant external beam radiation therapy (EBRT), androgen deprivation therapy (ADT), or both (MaxRP), as well as a regimen without surgery that includes EBRT, ADT, and brachytherapy (MaxRT). In this cohort study, MaxRP was compared to MaxRT to compare prostate cancer-specific mortality in patients with Gleason 9 or 10, T1-4N0M0 prostate cancer (n=130). Researchers found that at a median follow-up of 5.51 years in the MaxRT group and 4.78 years in the group that underwent surgery, there was no significant difference in prostate-cancer specific mortality (HR 1.33, 95% CI 0.49 to 3.64, p=0.58) when comparing MaxRP and MaxRT, yielding a plausibility index for equivalence of 76.75%. There was also no significant difference between MaxRP and MaxRT in terms of all-cause mortality (HR 0.80, 95% CI 0.36 to 1.81, p=0.60), corresponding to a plausibility index of 77.97%. Investigators therefore concluded that it is plausible MaxRP and MaxRT regimens lead to equivalent risk of prostate cancer-specific and all-cause mortality in patients with a Gleason score of 9 or 10.

Click to read the study in JAMA Oncology

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