Comparing radio-hormone therapy to radical prostatectomy for patients with high-risk localized prostate cancer in an Afro-Caribbean population.

INTRODUCTION

Recommended treatments for patients with localized high-risk prostate cancer include radiotherapy with long-term hormone therapy and radical prostatectomy with lymph node dissection. Data regarding these treatments, for patients of African ancestry, are limited. This study aims to compare oncologic outcomes in an Afro-Caribbean population.

METHODS

This monocentric retrospective study included 169 patients treated for localized high-risk prostate cancer with either radical prostatectomy or radiotherapy combined with long-term hormone therapy between January 1, 2016, and December 31, 2020. Descriptive statistics were used to evaluate patient characteristics, and survival analysis was conducted using the Kaplan-Meier method to estimate recurrence-free survival and overall survival. Univariate and multivariate analyses were performed using Cox proportional hazards models. All analyses were conducted with Statview 5.0 and MedCalc version 17.5.

RESULTS

Of the patients, 79 were treated with radical prostatectomy, and 90 received radiotherapy combined with at least 2 years of hormone therapy. The 5-year recurrence-free survival rates were 18% for surgery and 70.2% for radiotherapy with hormone therapy (P<0.001). Univariate analysis identified PSA level, prostate volume, ISUP score, pathologic score of surgical specimens, and treatment type as predictive factors for biochemical recurrence. Multivariate analysis showed that PSA level, prostate volume, and treatment type were significantly associated with recurrence risk.

CONCLUSION

This study suggests that radiotherapy combined with long-term hormone therapy is superior in terms of recurrence-free survival for patients with localized high-risk prostate cancer in an Afro-Caribbean population. Radical prostatectomy may be considered for carefully selected patients, particularly in a multimodal treatment setting.