Oncological outcomes of patients with ductal adenocarcinoma of the prostate receiving radical prostatectomy or radiotherapy

doi:10.1016/j.ajur.2020.05.005

Asian Journal of Urology, 2021, 8 (2): 227-234 doi: 10.1016/j.ajur.2020.05.005

Original Articles

Oncological outcomes of patients with ductal adenocarcinoma of the prostate receiving radical prostatectomy or radiotherapy

Mengzhu Liu^a,Kun Jin^a,Shi Qiu^a,b,Pengyong Xu^c,Mingming Zhang^a,Wufeng Cai^a,Xiaonan Zheng^a,Lu Yang^a,*(

),Qiang Wei^a

^a Institute of Urology, Department of Urology, West China Hospital, Sichuan University, Chengdu, China
^b Center of Biomedical Big Data, West China Hospital, Sichuan University, Chengdu, China
^c Institute of Urology, Department of Urology, the First People’s Hospital, Yantai, China

Abstract
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Abstract

Objective To evaluate the oncological outcomes of ductal adenocarcinoma of the prostate (DAC) managed with radical prostatectomy (RP) or radiotherapy (RT) and optimize the proper treatment modality to DAC comprehensively.
Methods The cohorts included a total of 528 patients from the Surveillance, Epidemiology and End Results (SEER) database, 354 receiving RP and 174 receiving RT. Cox proportional hazards regressions were performed to assess cancer specific mortality (CSM) and overall mortality (OM) between treatment groups. A competing risk analysis was further conducted. Subgroup analyses by age and level of prostate-specific antigen (PSA) were performed. Propensity score matching was implemented.
Results Patients managed with RP had lower risks of CSM and OM compared with RT (before matching: Hazard ratio [HR]=0.24, 95% confidence interval [CI] 0.13-0.47 and HR=0.26, 95% CI 0.17-0.40, respectively; after matching: HR=0.18, 95% CI 0.04-0.82 and HR=0.28, 95% CI 0.11-0.70, accordingly). Subgroup analyses demonstrated that patients in the middle tertile of the age or with lower tertile PSA level managed with RP took lower risks of OM significantly (HR=0.18, 95% CI 0.06-0.57, p<0.01 and HR=0.17, 95% CI 0.06-0.54, p<0.01).
Conclusion Among patients with DAC, treatment with RP was associated with better survival outcomes in comparison with RT. Patients with DAC in the middle tertile of the age and with lower tertile PSA level benefited the most from RP.

Key words： Ductal adenocarcinoma of the prostate Cancer specific mortality Overall mortality Radical prostatectomy Radiotherapy

Received: 24 July 2019 Available online: 23 May 2020

Corresponding Authors: Lu Yang E-mail: wycleflue@163.com

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Cite this article:

Mengzhu Liu,Kun Jin,Shi Qiu, et al. Oncological outcomes of patients with ductal adenocarcinoma of the prostate receiving radical prostatectomy or radiotherapy[J]. Asian Journal of Urology, 2021, 8(2): 227-234.

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http://www.ajurology.com/EN/10.1016/j.ajur.2020.05.005 OR http://www.ajurology.com/EN/Y2021/V8/I2/227

Baseline characteristics of patients with DAC.

Cox proportional hazards regression models of CSM and OM.

Kaplan-Meier analyses depicting cancer-specific mortality rates. (A) Survival curves; (B) Number at risk at different times; (C) Number of censoring at different times. RT, radiotherapy; RP, radical prostatectomy.

Kaplan-Meier analyses depicting overall mortality rates. (A) Survival curves; (B) Number at risk at different times; (C) Number of censoring at different times. RT, radiotherapy; RP, radical prostatectomy.

Kaplan-Meier analyses depicting cancer-specific mortality rates after propensity score matching. (A) Survival curves; (B) Number at risk at different times; (C) Number of censoring at different times. RT, radiotherapy; RP, radical prostatectomy.

Kaplan-Meier analyses depicting overall mortality rates after propensity score matching. (A) Survival curves; (B) Number at risk at different times; (C) Number of censoring at different times. RT, radiotherapy; RP, radical prostatectomy.

Subgroup analyses by age and PSA level.

Baseline characteristics of patients with DAC after propensity score matching.

Cox proportional hazards regression models of CSM and OM after propensity score matching.

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