Investig Clin Urol.  2021 Sep;62(5):535-544. 10.4111/icu.20210079.

A comparison of the survival outcomes of robotic-assisted radical prostatectomy and radiation therapy in patients over 75 years old with non-metastatic prostate cancer: A Korean multicenter study

Affiliations
  • 1Department of Urology, College of Medicine, Yeungnam University, Daegu, Korea
  • 2Department of Urology, Pusan National University Yangsan Hospital, Pusan, Korea
  • 3Department of Urology, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
  • 4Center for Urological Cancer, National Cancer Center, Goyang, Korea
  • 5Department of Urology, Seoul National University College of Medicine, Seoul, Korea
  • 6Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
  • 7Department of Urology, Samsung Medical Center, Seoul, Korea

Abstract

Purpose
To compare overall survivals (OSs) and cancer-specific survivals (CSSs) after robotic-assisted radical prostatectomy (RARP) and radiation therapy (RT), the latter of which has long been recommended primarily for elderly patients (≥75 years) with nonmetastatic prostate cancer (PCa), given the Korean male life span of 79.7 years (2018).
Materials and Methods
Retrospective data for aged ≥75 years who underwent RARP or RT at seven tertiary hospitals were analyzed. To account for indication-related bias, inverse probability of treatment-weighting (IPTW) was applied before and after Cox regression.
Results
Of the 1,110 study subjects, 883 underwent RARP and 227 RT from 2007 to 2016. The differences between groups including the age (≥80 y; 25.4% vs. 32.8%; p=0.034), concomitant diabetes (14.9% vs. 22.9%; p=0.007), coronary heart disease (3.5% vs. 7.5%; p=0.015), and PCa risk stratification (high-risk; 18.2% vs. 59.7%; p<0.001) were balanced after IPTW. During a mean followup of 74.5 months, OSs (91.9% vs. 91.0%) and CSSs (97.8% vs. 98.0%) were similar. After IPTW, overall mortality was associated with diabetes (hazard ratio [HR], 2.273; p<0.0001) and inversely with low-risk PCa (HR, 0.314; p<0.0001), the last of which was solely associated with cancer-specific mortality (HR, 0.245; p=0.0005). The implementation of local treatment between RARP and RT demonstrated no impact on survival, for whole and high-risk populations.
Conclusions
Even aged over 75 years, patients who underwent RARP for non-metastatic PCa had similar survival with RT regardless of risk stratification. However, the survival needs to be weighed with the morbidity of local treatment in a future study.

Keyword

Mortality; Prostatectomy; Radiotherapy; Robotic surgical procedures
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