Comparison of the Efficacy of Definitive Radiotherapy and Radical Prostatectomy in High-Risk Prostate Cancer: A Single-Center Experience

Objective: This retrospective study aimed to examine treatment outcomes and patient selection criteria in individuals with high-risk prostate cancer (PCa) treated with definitive radiotherapy (RT) and androgen deprivation therapy (ADT) or radical prostatectomy (RP). Materials and Methods: In total, 72 patients treated with definitive RT or RP for high-risk PCa between 2011 and 2018 were included in the study. Patient characteristics, treatment data, and follow-up data were obtained from the patient's file. Results: Of 72 patients with high-risk PCa, 34 (46.6%) received definitive RT and ADT and 38 (52.1%) had undergone RP. The median follow-up time in the RP group was 44.5 (range, 14-100) months and that in the RP group was 48 (range, 9-108) months. No significant between-group difference was found in the biochemical recurrence-free survival, metastasis-free survival, and overall survival (OS) rates after 3 and 5 years of follow-ups (p >= 0.005). In a subgroup analysis, RT was the treatment of choice for patients aged >= 65 years and for those with prostate-specific antigen values of >= 20 ng/dL, a Gleason score (GS) of 9-10, and T stage T3-4 and N+ status (p=0.015, 0.001, 0.035, and 0.022, respectively). In the univariate and multivariate analyses, age z65 years and GS of 8-10 were significant risk factors for reduced OS in all high-risk PCa cases. Conclusion: No significant difference was found in the survival outcome of patients in the RT + ADT and RP groups. RT should be preferred in patients aged >= 65 years and in those with a high T stage and GS of 8-10.