Six-year outcomes of robot-assisted radical prostatectomy versus volumetric modulated arc therapy for localized prostate cancer: A propensity score-matched analysis

Michio Noda; Satoru Taguchi; Kenshiro Shiraishi; Tetsuya Fujimura; Akihiro Naito; Taketo Kawai; Jun Kamei; Yoshiyuki Akiyama; Yuta Yamada; Yusuke Sato; Daisuke Yamada; Tohru Nakagawa; Hideomi Yamashita; Keiichi Nakagawa; Osamu Abe; Hiroshi Fukuhara; Haruki Kume

doi:10.1007/s00066-023-02192-5

Six-year outcomes of robot-assisted radical prostatectomy versus volumetric modulated arc therapy for localized prostate cancer: A propensity score-matched analysis

Strahlenther Onkol. 2024 Jan 5. doi: 10.1007/s00066-023-02192-5. Online ahead of print.

Authors

Michio Noda^{1

2}, Satoru Taguchi³, Kenshiro Shiraishi^{4

5}, Tetsuya Fujimura⁶, Akihiro Naito¹, Taketo Kawai^{1

2}, Jun Kamei¹, Yoshiyuki Akiyama¹, Yuta Yamada¹, Yusuke Sato¹, Daisuke Yamada¹, Tohru Nakagawa², Hideomi Yamashita⁵, Keiichi Nakagawa⁵, Osamu Abe⁵, Hiroshi Fukuhara⁷, Haruki Kume¹

Affiliations

¹ Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan.
² Department of Urology, Teikyo University School of Medicine, Tokyo, Japan.
³ Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan. satorutaguchi33@gmail.com.
⁴ Department of Radiology, Teikyo University School of Medicine, Tokyo, Japan.
⁵ Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan.
⁶ Department of Urology, Jichi Medical University, Tochigi, Japan.
⁷ Department of Urology, Kyorin University School of Medicine, Tokyo, Japan.

PMID: 38180494
DOI: 10.1007/s00066-023-02192-5

Abstract

Background: Although robot-assisted radical prostatectomy (RARP) and intensity-modulated radiotherapy are the leading respective techniques of prostatectomy and radiotherapy for localized prostate cancer, almost no study has directly compared their outcomes; none have compared mortality outcomes.

Methods: We compared 6‑year outcomes of RARP (n = 500) and volumetric modulated arc therapy (VMAT, a rotational intensity-modulated radiotherapy, n = 360) in patients with cT1-4N0M0 prostate cancer. We assessed oncological outcomes, namely overall survival (OS), cancer-specific survival (CSS), radiological recurrence-free survival (rRFS), and biochemical recurrence-free survival (bRFS), using propensity score matching (PSM). We also assessed treatment-related complication outcomes of prostatectomy and radiotherapy.

Results: The median follow-up duration was 79 months (> 6 years). PSM generated a matched cohort of 260 patients (130 per treatment group). In the matched cohort, RARP and VMAT showed equivalent results for OS, CSS, and rRFS: both achieved excellent 6‑year outcomes for OS (> 96%), CSS (> 98%), and rRFS (> 91%). VMAT had significantly longer bRFS than RARP, albeit based on different definitions of biochemical recurrence. Regarding complication outcomes, patients who underwent RARP had minimal (2.6%) severe perioperative complications and achieved excellent continence recovery (91.6 and 68.8% of the patients achieved ≤ 1 pad/day and pad-free, respectively). Patients who underwent VMAT had an acceptable rate (20.0%) of grade ≥ 2 genitourinary complications and a very low rate (4.4%) of grade ≥ 2 gastrointestinal complications.

Conclusion: On the basis of PSM after a 6-year follow-up, RARP and VMAT showed equivalent and excellent oncological outcomes, as well as acceptable complication profiles.

Keywords: External beam radiotherapy; Intensity-modulated radiotherapy; Prostate cancer; Robot-assisted radical prostatectomy; Volumetric modulated arc therapy.