Comparison of the effectiveness of radiation and surgical treatment methods in high and very high risk prostate cancer

Aim. To perform comparative analysis of overall and recurrence-free survival in patients with prostate cancer (PCa) of high and very high risk (HVHR) receiving combination treatment based on surgical or radiation therapy.Materials and methods. Between 2012 and 2022 at the N.N. Petrov National Medical Research Center of Oncology (Saint Petersburg), 2 prospective studies were performed. In 138 patients with HVHR PCa (mean age 63.1 ± 6.6 years, median followup 28.7 (12.4; 45.6) months), comparative analysis of the effectiveness of radical prostatectomy with extended lymph node dissection in combination with neoadjuvant chemohormonal therapy or without it was performed. In the parallel independent prospective study, in 220 patients with HVHR PCa (mean age 667 ± 6.5 years, median follow-up 61.3 (49.1; 82.3) months), the effectiveness of combination radiation therapy with simultaneous androgen deprivation therapy (ADT) was evaluated: pelvic lymph nodes and prostate were irradiated in accordance with the standard dose fractionation (total focal dose 46–50 Gy) with subsequent additional prostate irradiation using brachytherapy or stereotactic radiotherapy.Results. In the patient group receiving surgical treatment, actuarial 5-year survival without the signs of biochemical recurrence was 35.7–44.2 % which was significantly lower than 67.1 % in the group receiving radiotherapy with ADT (р 0.0001, log-rank test). Five-year overall survival did not significantly differ between the compared groups and amounted to 88–90 % (р = 0.84, log-rank test).Conclusion. In patients with locally advanced HVHR PCa, radiotherapy in combination with ADT leads to significant increase in biochemical recurrence-free survival compared to patients who underwent prostatectomy with extended lymph node dissection including cases where surgery was combined with neoadjuvant ADT or chemohormonal therapy.