Comparison of the effectiveness of radiation and surgical treatment methods in high and very high risk prostate cancer

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Abstract

          

Aim. To perform comparative analysis of overall and recurrence-free survival in patients with prostate cancer (PCa) of high and very high risk (HVHR) receiving combination treatment based on surgical or radiation therapy.

Materials and methods. Between 2012 and 2022 at the N.N. Petrov National Medical Research Center of Oncology (Saint Petersburg), 2 prospective studies were performed. In 138 patients with HVHR PCa (mean age 63.1 ± 6.6 years, median followup 28.7 (12.4; 45.6) months), comparative analysis of the effectiveness of radical prostatectomy with extended lymph node dissection in combination with neoadjuvant chemohormonal therapy or without it was performed. In the parallel independent prospective study, in 220 patients with HVHR PCa (mean age 667 ± 6.5 years, median follow-up 61.3 (49.1; 82.3) months), the effectiveness of combination radiation therapy with simultaneous androgen deprivation therapy (ADT) was evaluated: pelvic lymph nodes and prostate were irradiated in accordance with the standard dose fractionation (total focal dose 46–50 Gy) with subsequent additional prostate irradiation using brachytherapy or stereotactic radiotherapy.

Results. In the patient group receiving surgical treatment, actuarial 5-year survival without the signs of biochemical recurrence was 35.7–44.2 % which was significantly lower than 67.1 % in the group receiving radiotherapy with ADT (р <0.0001, log-rank test). Five-year overall survival did not significantly differ between the compared groups and amounted to 88–90 % (р = 0.84, log-rank test).

Conclusion. In patients with locally advanced HVHR PCa, radiotherapy in combination with ADT leads to significant increase in biochemical recurrence-free survival compared to patients who underwent prostatectomy with extended lymph node dissection including cases where surgery was combined with neoadjuvant ADT or chemohormonal therapy.

About the authors

S. N. Novikov

N.N. Petrov National Medical Research Center of Oncology, Ministry of Health of Russia

Author for correspondence.
Email: krokon@mail.ru
ORCID iD: 0000-0002-7185-1967

68 Leningradskaya St., Pesochnyy, Saint Petersburg 197758

Russian Federation

E. E. Samartseva

N.N. Petrov National Medical Research Center of Oncology, Ministry of Health of Russia; I.I. Mechnikov North-West State Medical University, Ministry of Health of Russia

Email: samarceva83@bk.ru
ORCID iD: 0009-0008-8585-0982

Ph.D. of Medical Sciences, urologist-oncologist, radiation oncologist, Department of Radiotherapy

68 Leningradskaya St., Pesochnyy, Saint Petersburg 197758; 
|41 Kirochnaya St., Saint Petersburg 191015

Russian Federation

R. V. Novikov

N.N. Petrov National Medical Research Center of Oncology, Ministry of Health of Russia;
S.M. Kirov Military Medical Academy, Ministry of Defense of Russia

Email: novikov-spb@mail.ru
ORCID iD: 0000-0003-1873-1293

Doctor of Medical Sciences, Leading Researcher of the Federal State Budgetary Institution “National Medical Research Center of Oncology named after. N.N. Petrov" ; Professor of the Department of Urology of Military Medical Academy named after S. M. Kirov 

68 Leningradskaya St., Pesochnyy, Saint Petersburg 197758; 
6 Akademika Lebedeva St., Saint Petersburg 194044

Russian Federation

A. K. Nosov

N.N. Petrov National Medical Research Center of Oncology, Ministry of Health of Russia

Email: nakuro@yandex.ru
ORCID iD: 0000-0003-3850-7109

Doctor of Medical Sciences, senior researcher,
Head of the Department of Oncourology

68 Leningradskaya St., Pesochnyy, Saint Petersburg 197758

Russian Federation

S. A. Protsenko

N.N. Petrov National Medical Research Center of Oncology, Ministry of Health of Russia

Email: s.protsenko@list.ru
ORCID iD: 0000-0001-8704-7669

Doctor of Medical Sciences, Professor, Head of the Department of Chemotherapy and Innovative Technologie

68 Leningradskaya St., Pesochnyy, Saint Petersburg 197758

Russian Federation

N. N. Buevich

N.N. Petrov National Medical Research Center of Oncology, Ministry of Health of Russia

Email: buevich_nn@list.ru
ORCID iD: 0000-0001-9937-0439

Ph.D. of Medical Sciences, oncologist, chemotherapist, outpatient department No. 1

68 Leningradskaya St., Pesochnyy, Saint Petersburg 197758

Russian Federation

S. B. Petrov

N.N. Petrov National Medical Research Center of Oncology, Ministry of Health of Russia;
I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia

Email: petrov-uro@yandex.ru
ORCID iD: 0000-0003-3460-3427

Doctor of Medical Sciences, Professor, Honored Doctor of the Russian Federation, Leading Researcher of the Scientific Department of General Oncology and Urology of tN.N. Petrov National Medical Research Center of Oncology; head of the Urology Research Center of the First St. Petersburg State Medical University  named after acad. I.P. Pavlova

68 Leningradskaya St., Pesochnyy, Saint Petersburg 197758; 
6–8 L’va Tolstogo St., Saint Petersburg 197022

 

Russian Federation

N. D. Ilyin

N.N. Petrov National Medical Research Center of Oncology, Ministry of Health of Russia

Email: ilinnd@rumbler.ru
ORCID iD: 0000-0001-6472-0427

Radiation oncologist, department of radiotherapy

68 Leningradskaya St., Pesochnyy, Saint Petersburg 197758

Russian Federation

Yu. O. Merezhko

N.N. Petrov National Medical Research Center of Oncology, Ministry of Health of Russia

Email: shihtmaht@yandex.ru
ORCID iD: 0000-0003-1491-2644

Radiation oncologist, department of radiotherapy

68 Leningradskaya St., Pesochnyy, Saint Petersburg 197758

Russian Federation

F. E. Antipov

N.N. Petrov National Medical Research Center of Oncology, Ministry of Health of Russia

Email: antipovmd@gmail.com
ORCID iD: 0000-0002-8505-4977

Radiation oncologist, department of radiotherapy

68 Leningradskaya St., Pesochnyy, Saint Petersburg 197758

Russian Federation

S. V. Kanaev

N.N. Petrov National Medical Research Center of Oncology, Ministry of Health of Russia

Email: kanaev69@mail.ru
ORCID iD: 0000-0002-1753-7926

Doctor of Medical Sciences, Professor, Honored Doctor of the Russian Federation, Head of the Scientific Department of Radiation Oncology and Radiation Diagnostics

68 Leningradskaya St., Pesochnyy, Saint Petersburg 197758

Russian Federation

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