Comparative Oncological Outcomes Following Radical Prostatectomy or External Beam Radiation Therapy Plus Androgen Deprivation Therapy in Men with Clinical T3b Prostate Cancer

Abstract Purpose To compare oncological outcomes in men with clinical T3b prostate cancer who underwent radical prostatectomy (RP) or a combination of radiation therapy plus androgen deprivation therapy (HT + RT).Materials and Methods Men with clinical T3b prostate cancer who underwent RP or HT + RT between 2007 and 2014 were evaluated. All patients were relatively healthy, with Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 without nodal or distant metastasis. Cancer-specific survival (CSS) was analyzed. Age, biopsy Gleason score, and initial prostate specific antigen (PSA) concentration were adjusted by propensity score matching. Cox proportional hazard model was used to assess factors prognostic of CSS.Results Of the 152 patients with clinical T3b prostate cancer, 45 underwent RP and 107 underwent HT + RT between 2007 and 2014. Mean CSS was significantly longer in the RP than in the HT + RT group (p = 0.029). Age, biopsy Gleason score, and pretreatment PSA concentration were significantly higher in the HT + RT group. In the propensity score matched population of 34 patients each, CSS remained significantly longer in the RP than in the HT + RT group (125.21 ± 5.10 months vs. 107.73 ± 9.01 months, p = 0.041). Multivariate analysis showed that undergoing HT + RT was the only significant poor prognostic factor for CSS (hazard ratio = 2.849; 95% confidence interval, 1.086–7.473, p = 0.033).Conclusion CSS was significantly longer in men with clinical T3b prostate cancer who underwent RP than HT + RT, suggesting that RP should be the initial treatment of choice for these patients.