Introduction:
Ductal adenocarcinoma of the prostate is a rare subtype of prostate cancer (PCa), making up 0.4-0.8% of all cases, and is associated with delayed diagnosis and aggressive behavior similar to that of Gleason score 8-10 acinar adenocarcinoma. Although ductal PCa is typically treated with radical prostatectomy (RP) or radiotherapy, the efficacy of treatments for men with this rare histological subtype remains controversial. Using the Surveillance, Epidemiology, and End Results (SEER) database, we evaluated the impact of RP and external beam radiation therapy with/without brachytherapy (EBRT+/-BT) on survival outcomes for men with localized ductal PCa.
Methods:
The SEER database was used to gather information on men diagnosed with ductal PCa from 2004-2016. Patients diagnosed with localized disease (TxN0M0), Gleason Score of 8-10 were included. Patients were divided into two groups based on the treatment as RP and EBRT+/-BT. Logistic regression was used to identify factors predicting RP treatment. Kaplan-Meier curve and Cox regression were used for survival analysis.
Results:
159 patients were included, with 120 received RP and 39 received EBRT+/-BT(Table 1). Patients are much younger in surgical group(64.1 vs 71.1 years, p<0.001), have lower PSA(p=0.037), with the other parameters comparable. On logistic regression, age>75 years (OR=0.085, 95%CI 0.029-0.244, p<0.001) and PSA>20ng/ml (OR=0.146, 95%CI 0.035-0.603, p=0.008) were less likely to receive RP. With a mean follow-up time of 58 months, the 5-year-OS was RP 94.2% vs EBRT+/-BT 92.3% (p=0.708), 5-year-DSS: RP 96.7% vs EBRT+/-BT 92.3% (p=0.364). Survival analysis with KM-curve showed that patients achieved similar OS and DSS with RP and EBRT+/-BT (all p>0.05)(Figure 1). On Cox regression, Gleason Score of 9 (HR=4.117, 95%CI 1.566-10.823, p=0.004), 10 (HR=20.283, 95%CI 1.989-206.89,p=0.011), PSA level between 10-20ng/ml (HR=4.219, 95%CI 1.228-14.497, p=0.022) were independent risk factors for worse survival, while RP (HR=1.049, 95%CI 0.332-3.316, p=0.936) was not independently associated with survival, after controlling for age, year of diagnosis, race, and marital status.
Conclusion:
Our data showed that patients with localized ductal PCa could achieve similar survival benefits with RP or EBRT+/-BT.
Funding: N/A
Image(s) (click to enlarge):
IMPACT OF RADICAL PROSTATECTOMY AND RADIOTHERAPY ON SURVIVAL OUTCOMES IN MEN WITH DUCTAL PROSTATE CANCER
Category
Prostate Cancer > Potentially Localized
Description
Poster #182
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Presented By: Nicole Flegel
Authors:
Nicole Flegel
Shu Wang
Mohummad Minhaj Siddiqui