Comparison of Multimodal Therapies and Outcomes Among Patients With High-Risk Prostate Cancer With Adverse Clinicopathologic Features

• DOI: 10.1001/jamanetworkopen.2021.15312
• Publication Date: 2021-07-01T15:45:40Z
• Authors: Amar U. Kishan; R. Jeffrey Karnes; Tahmineh Romero; Jessica K. Wong; Giovanni Motterle; Jeffrey J. Tosoian; Bruce J. Trock; Eric A. Klein; Bradley J. Stish; Robert T. Dess; Daniel E. Spratt; Avinash Pilar; Chandana Reddy; Rebecca Levin-Eps...; Trude B. Wedde; Wolfgang A. Lilleby; Ryan Fiano; Gregory S. Merrick; Richard G. Stock; D. Jeffrey Demanes; Brian J. Moran; Michelle Bracciof...; Hartwig Huland; Phuoc T. Tran; Santiago Martin; Rafael Martínez-M...; Daniel J. Krauss; Eyad I. Abu-Isa; Ridwan Alam; Zeyad Schwen; Albert J. Chang; Thomas M. Pisansky; Richard Choo; Daniel Y. Song; Stephen Greco; Curtiland Deville; Todd McNutt; Theodore L. DeWeese; Ashley E. Ross; Jay P. Ciezki; Paul C. Boutros; Nicholas G. Nickols; Prashant Bhat; David Shabsovich; Jesus E. Juarez; Natalie Chong; Patrick A. Kupelian; Anthony V. D’Amico; Matthew B. Rettig; Alejandro Berlin; Jonathan D. Tward; Brian J. Davis; Robert E. Reiter; Michael L. Steinberg; David Elashoff; Eric M. Horwitz; Rahul D. Tendulkar; Derya Tilki
• Keywords: External beam radiotherapy; Interquartile range; Multimodal therapy

The optimal management strategy for high-risk prostate cancer and additional adverse clinicopathologic features remains unknown.To compare clinical outcomes among patients with after definitive treatment.This retrospective cohort study included (as defined by the National Comprehensive Cancer Network [NCCN]) at least 1 feature (defined as any primary Gleason pattern 5 on biopsy, T3b-4 disease, ≥50% cores biopsy results positive cancer, or NCCN ≥2 features) treated between 2000 2014 16 tertiary centers. Data were analyzed in November 2020.Radical prostatectomy (RP), external beam radiotherapy (EBRT) androgen deprivation therapy (ADT), EBRT plus brachytherapy boost (BT) ADT. Guideline-concordant multimodal treatment was RP appropriate use of (optimal RP), 2 years ADT EBRT), BT year BT).The outcome cancer-specific mortality; distant metastasis a secondary outcome. Differences evaluated using inverse probability weight-adjusted Fine-Gray competing risk regression models.A total 6004 men (median [interquartile range] age, 66.4 [60.9-71.8] years) analyzed, including 3175 (52.9%) who underwent RP, 1830 (30.5%) alone, 999 (16.6%) BT. Compared (subdistribution hazard ratio [sHR] 0.78, [95% CI, 0.63-0.97]; P = .03) alone (sHR, 0.70 0.53-0.92]; .01) associated significantly improved there no difference mortality 0.89 0.67-1.18]; .43). No significant differences found across cohorts 2940 received guideline-concordant multimodality (eg, vs RP: sHR, 0.76 0.52-1.09]; .14). However, consistently lower rates compared 0.50 0.44-0.58]; < .001).These findings suggest that unfavorable receiving therapy, equivalent those EBRT, BT, although more favorable Optimal is critical improving cancer.