PD63-03 Treatment intensification and outcome in high-risk prostate cancer: A multi-institutional consortium analysis.

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Journal of Urology


INTRODUCTION AND OBJECTIVE: External beam radiotherapy (EBRT) with androgen deprivation therapy (ADT), EBRT with a brachytherapy boost (EBRT+BT) with ADT, and radical prostatectomy (RP) with or without postoperative therapy are standard of care options for NCCN high-risk prostate cancer (HRPCa). Treatment intensification has been associated with improved outcomes, but the comparative effectiveness of these treatments remains unclear and analyses are complicated by the heterogeneity of outcomes within HRPCa. The goal of this study was to compare prostate cancer-specific mortality (PCSM) outcomes for patients receiving maximal treatments across modalities. METHODS: Individual patient data were for 9775 patients who received definitive treatment for HRPCa between 2000-2013 across multiple institutions. Unfavorable HRPCa was defined by the presence of any primary Gleason grade 5, cT3b-4, ≥50% cores positive on biopsy, or ≥2 NCCN high risk features. Maximal treatment was defined as follows: RP with adjuvant radiotherapy (Max RP), EBRT with ≥2 years ADT (Max EBRT), and EBRT+BT with ≥1 year ADT (Max EBRT+BT). Fine-Gray competing risks regression models with the inverse probability of treatment weight were used to evaluate PCSM outcomes across groups. Propensity scores included age-at-treatment, initial PSA, clinical T stage, and Gleason grade group as covariates. RESULTS: Median follow-up was 6.1 years. 7551 patients were classified as having favorable (n=2185) and unfavorable (n=5366) HRPCa. Among favorable HRPCa patients, proportions of maximal therapy receipt were as follows: 31/1525 (2.1%) RP, 123/384 (32%) EBRT, and 33/276 (11.9%) EBRT+BT. For unfavorable HRPCa, these proportions were: 201/3016 (6.6%) RP, 663/1573 (42.1%) EBRT, and 201/777 (25.8%) EBRT+BT. Patients with unfavorable HRPCa had significantly higher rates of PCSM than those with favorable HRPCa (p





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