INTRODUCTION AND OBJECTIVE:
To determine and compare overall survivals (OSs) and cancer-specific survivals (CSSs) after robotic-assisted radical prostatectomy (RARP) and radiation therapy (RT), the latter of which has long been recommended primarily for elderly patients (≥75 years) with non-metastatic prostate cancer (PCa), given the contemporary Korean life span of 79.7 years (2018).
Retrospective data for aged ≥ 75 years who underwent RARP or RT at seven tertiary hospitals were analyzed. To account for indication-related bias, inverse probability of treatment-weighting (IPTW) was applied before unadjusted and adjusted Cox proportional hazards regression modeling.
Of the 1,110 study subjects, 883 underwent RARP and 227 RT. Though there were differences in the age distribution (≥80 yrs; 25.4% vs 32.8%, p=.034), concomitant diabetes (14.9% vs 22.9%, p=.007) and coronary heart disease (3.5% vs. 7.5%, p=.015), and particularly in PCa risk stratification (high risk; 18.2 vs. 59.7%, p<.001) between groups, all of these were balanced after IPTW. During a mean follow-up of 74.5 months, OSs (91.9% vs. 91.0%) and CSSs (97.8% vs. 98.0%) were similar. After IPTW, OS was negatively associated with diabetes (HR=2.27, p<.001) and risk stratification (low-risk; HR=.0314, p<.001), the last of which was solely associated with CSS (HR=.245, p=.0005). The implementation of local treatment between RARP and RT demonstrated no impact on survival both in whole subjects and in the high-risk subpopulation.
Even the patient over 75 years old who could afford to undergo RARP for non-metastatic PCa had a similar survival in comparison with RT, regardless of risk stratification.
Source of Funding: