Comparative Effectiveness of Radical Prostatectomy Versus External Beam Radiation Therapy Plus Brachytherapy in Patients with High-risk Localized Prostate Cancer

A previous study comparing external beam radiation therapy with/without brachytherapy (EBRT +/- BT) and radical prostatectomy (RP) for high-risk localized prostate cancer (PCa) did not find a difference in overall survival (OS) between the treatments. However, this study was limited by short follow-up and assessment of OS in patients of divergent age and comorbidities. We therefore compared OS of EBRT+ BT versus RP in comparatively young (<= 65 yr) and healthy men (Charlson Comorbidity Index = 0) with high-risk localized PCa in the National Cancer Database. Inverse probability of treatment weighting (IPTW) adjustment was used to balance baseline characteristics. Median follow-up was 92 mo (interquartile range 78-108). Using IPTW-adjusted Cox regression analysis, EBRT + BT was associated with a higher risk of all-cause mortality compared with RP (hazard ratio = 1.22, 95% confidence interval 1.05-1.43). In young and healthy men presenting with high-risk localized PCa, RP showed statistically significant OS benefit compared with EBRT + BT. Patient summary: In an analysis restricted to young and healthy men presenting with high-risk localized prostate cancer, initial radical prostatectomy is associated with an overall survival benefit compared with external beam radiation therapy plus brachytherapy. (C) 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.