Local treatment vs. years of life lost in intermediate-risk prostate cancer
PURPOSE: The role of radical prostatectomy (RP) or radiotherapy (RT) in intermediate-risk prostate cancer (PCa) is still under debate. Our aim was to quantify the effect of RP and RT on the average years of life lost (YLL) in patients with intermediate-risk PCa. METHODS: Within the SEER database 2004-2021, intermediate-risk PCa patients aged 45-75 were identified. Stratification rested on local therapy type: RP vs. RT vs. none. We performed Monte Carlo simulation to generate individual survival estimates based on Social Security Administration life tables. Subsequently, YLL was compared between PCa patients and matched population controls. RESULTS: Of 220,113 intermediate-risk PCa patients, 94,452 (42.9%), 85,232 (38.7%), and 40,429 (18.4%) underwent RP, RT, and no local therapy, respectively. Compared to population controls, RP and RT patients did not exhibit YLL disadvantages. Conversely, no local therapy patients exhibited a survival disadvantage of 0.21 YLL (p < 0.001). In the subgroup of patients diagnosed at age 45-55, a YLL disadvantage was seen for no local therapy (1.32) and RT patients (0.69), while their RP counterparts did not exhibit a YLL disadvantage. In further subgroup analyses, a substantial YLL disadvantage was recorded in unfavorable intermediate-risk PCa patients without local therapy (0.47 YLL), whereas no YLL disadvantage was seen in unfavorable intermediate-risk PCa patients who underwent RP or RT. CONCLUSION: In intermediate-risk PCa, no YLL disadvantage was observed in RP and RT patients within all subgroups. Patients diagnosed at a young age and with unfavorable cancer characteristics are at increased risk for premature death if not locally treated. TRIAL REGISTRATION: doi10.17605 OSF.IO/D2RUV.
Authors
- Carlotta Palumbo (ORCID: https://orcid.org/0000-0002-6165-5276)
- Felix K.‐H. Chun (ORCID: https://orcid.org/0000-0001-8486-9536)
- Markus Graefen (ORCID: https://orcid.org/0000-0003-3609-3512)
- Fabian Falkenbach (ORCID: https://orcid.org/0000-0003-1907-3982)
- Andrea Marmiroli (ORCID: https://orcid.org/0009-0005-7241-8793)
- Michele Nicolazzini (ORCID: https://orcid.org/0009-0003-7773-5101)
- Alberto Briganti (ORCID: https://orcid.org/0000-0002-2178-0494)
- Jordan A. Goyal (ORCID: https://orcid.org/0009-0006-4609-8981)
- Mattia Longoni (ORCID: https://orcid.org/0000-0002-2613-2306)
- Gennaro Musi (ORCID: https://orcid.org/0000-0003-0833-9183)
- Fred Saad C (ORCID: https://orcid.org/0000-0003-2986-5617)
- Lars Budäus (ORCID: https://orcid.org/0000-0001-8932-7787)
- Pierre I. Karakiewicz (ORCID: https://orcid.org/0000-0003-1354-5854)
- Federico Polverino (ORCID: https://orcid.org/0009-0007-6218-3761)
- Riccardo Schiavina (ORCID: https://orcid.org/0000-0003-4679-8196)
- Shahrokh F. Shariat
- Calogero Catanzaro (ORCID: https://orcid.org/0009-0004-6265-5288)
- Quynh Chi Le (ORCID: https://orcid.org/0009-0008-9209-8776)
Institutions
- Al-Ahliyya Amman University (JO)
- Goethe University Frankfurt (DE)
- Università degli Studi del Piemonte Orientale “Amedeo Avogadro” (IT)
- Vita-Salute San Raffaele University (IT)
- University of Milan (IT)
- University Hospital Heidelberg (DE)
- Comprehensive Cancer Center Vienna (AT)
- IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola (IT)
- University Medical Center Hamburg-Eppendorf (DE)
- Martini-Klinik (DE)
- Azienda Ospedaliero Universitaria Maggiore della Carita (IT)
- University Hospital Frankfurt (DE)
- Weill Cornell Medicine (US)
- University of Turin (IT)
- European Institute of Oncology (IT)
- Université de Montréal (CA)
- University of Naples Federico II (IT)
- Medical University of Vienna (AT)
- The University of Texas Southwestern Medical Center (US)
- University of Bologna (IT)
Publication Details
- Journal
- World Journal of Urology
- Published
- 2026-10-30
- DOI
- https://doi.org/10.1007/s00345-026-06858-4
- Primary Topic
- Prostate Cancer Diagnosis and Treatment
- Type
- article
- Field-Weighted Citation Impact
- 0.00