Comparison of the prognoses after two different surgical procedures plus radiotherapy in the treatment of patients with prostate cancer: survival analysis based on propensity score matching.

Purpose: The association between different surgical methods combined with radiotherapy and the prognosis of patients with prostate cancer is still unclear. We retrospectively analyzed and compared the prognosis of TURP combined with radiotherapy and RP combined with radiotherapy for prostate cancer based on the SEER database.

Methods: We reviewed the SEER database for patients diagnosed with prostate cancer from 2010 to 2015. After propensity score matching, we performed IPTW on the data and performed a survival analysis on the data. KM curve and Cox survival analysis were used to report the association between different surgical methods combined with chemotherapy and the prognosis of prostate cancer patients. Subgroup analysis was used to report the consistency and stability of the results between different patient characteristics.

Results: A total of 11,782 patients with prostate cancer were included in this study, Among them, there were 1758 cases (6.52%) in the TURP group and 10,024 cases (92.97%) in the RP group. A total of 928 patients were included in the study after PSM. Cox regression after PSM and IPTW showed that the prognosis of patients in the TURP group combined with radiotherapy was worse. Compared with the RP group combined with radiotherapy group, the TURP group combined with radiotherapy group had a 253% higher risk of death (HR = 3.53, 95%CI2.37-4.59, P < 0.001), and the prognosis of patients in the Gleason ≥ 8 subgroup was even worse. Compared with the Gleason ≤ 7 subgroup, the Gleason ≥ 8 subgroup had a 58% higher risk of death (HR = 158, 95% CI 1.43-1.59, P < 0.001). In addition, subgroup analysis and forest plots after PSM and IPTW showed that there was no significant difference between RP combined with radiotherapy and TURP combined with radiotherapy in the high-, medium-, and low-risk groups, the T staging subgroup without lymph node and distant metastasis, and the Gleason subgroup. It benefited more in patients aged 45-74 years.

Conclusion: RP combined with radiotherapy is associated with a better prognosis than TURP combined with radiotherapy, Patients in the Gleason ≤ 7 subgroup had a better prognosis than those in the Gleason ≥ 8 subgroup, and both surgical approaches combined with radiotherapy benefited more patients aged 45-74 years.