Abstract 339P
Background
High-risk/Very High-Risk Prostate Cancer (HR/VHR-PC) is highly invasive with malignant potential. NCCN advises radiation therapy and surgery, but RP often leads to high recurrence rates. Limited research exists on SBRT for HR/VHR-PC. Our study aims to compare SBRT and RP outcomes in HR/VHR-PC across multiple institutions.
Methods
Retrospective review of data from three centers (2007-2021). Inclusion: age ≥18, pathologically diagnosed with prostate adenocarcinoma, meeting NCCN high-risk criteria. Treatments: RP or SBRT. 119 had SBRT, 197 had RP. Follow-up included monthly PSA monitoring. Endpoints: bPFS, PFS, OS, CSS. Analysis: R software, logistic regression, propensity score matching, Kaplan-Meier, Cox regression.
Results
Data from three hospitals, 316 HR/VHR-PC patients analyzed. Initial treatments: RP (119) and SBRT (197). After PSM, 238 cases analyzed, median follow-up 69.04 (7.57-161.57) months. bPFS: RP 41.18%, SBRT 23.53%. Median bPFS: RP 84.17 months, SBRT 126.93 months. 3-, 5-, and 7-year bPFS rates: RP 67.9%, 36%, 58.25%; SBRT 92.8%, 80.5%, 72.10% (p<0.001). Factors influencing bPFS included Gleason score (HR=1.564, p=0.001), post-treatment ADT (HR=3.242, p<0.001), and subsequent prostate treatment (HR=2.780, p<0.001). For RP, comorbidities, postoperative Gleason score, and capsule invasion correlated with bPFS; for SBRT, subsequent treatment and Gleason score were predictors. In RP cohort, 33 patients (27.73%) experienced progression, recurrence, or metastasis, compared to 18 patients (15.13%) in SBRT group. 3-, 5-, and 7-year PFS rates: RP 88.7%, 75.8%, 60.2%; SBRT 95.5%, 89.3%, 79.9% (p=0.002). CSS rates: RP 100%, 97.5%, 88.9%; SBRT 99.1%, 95.9%, 91.7% (p=0.954). Median OS: SBRT 130.81 months, RP 135.55 months. 3-, 5-, and 7-year OS rates: SBRT 98.2%, 90.0%, 75.2%; RP 99.2%, 96.7%, 83.5% (p=0.081). RP group had more postoperative treatments.
Conclusions
RP patients had higher rates of adjuvant/salvage therapy, but SBRT patients exhibited better trends in PFS and bPFS. Both groups had high CSS and OS rates.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.