Postoperative Treatment and Survival in Locally Advanced Prostate Cancer: Real-World Outcomes.

OBJECTIVE

To evaluate real-world postoperative treatment patterns and survival outcomes among men with nonmetastatic locally advanced prostate cancer (laPCa) undergoing radical prostatectomy (RP) to improve the shared decision-making process.

MATERIAL AND

METHODS

All 3022 patients diagnosed with laPCa prostate cancer and registered in Cancer registry of Norway (CRN) who underwent RP within 1 year after diagnosis during 2008-21 were included. Data on disease characteristic's and radiotherapy were derived from the CRN and data on endocrine treatment and additional systemic therapy (docetaxel, abiraterone, enzalutamide) were provided from the Norwegian Prescription Database and the Norwegian Patient Registry. Cause-specific mortality was estimated using a competing risk framework. Overall survival was calculated as 1 minus the all-cause mortality. The cumulative probability of starting postoperative treatment for relapse was also calculated.

RESULTS

Median follow-up was 4.8 years. Within 10 years post-RP, 34% received postoperative radiotherapy, 19% received endocrine therapy as first treatment, and 14% received additional systemic therapy. Higher PSA, cT3b stage, and ISUP grade 4 to 5 were associated with increased likelihood of postoperative treatment. The 10-year overall mortality was 16%, with most deaths from non-prostate cancer causes. Patients receiving postoperative radiotherapy had low 10-year prostate cancer-specific mortality (2%), whereas those starting endocrine therapy first experienced higher prostate cancer mortality (31%). Among patients progressing to systemic therapy, 5-year mortality was 65%, predominantly due to prostate cancer.

CONCLUSION

In this large, unselected national cohort, laPCa patients treated with RP had generally favorable long-term survival, but more than half required relapse-directed therapy within 10 years. Relapse risk was strongly linked to baseline tumor characteristics and persisted throughout follow-up, underscoring the need for prolonged surveillance. Future studies should address long-term functional outcomes and quality-of-life after multimodal postoperative treatment.