World Journal of Urology

, Volume 36, Issue 9, pp 1399–1407 | Cite as

Survival after radical prostatectomy or radiotherapy for locally advanced (cT3) prostate cancer

  • Marco BandiniEmail author
  • Michele Marchioni
  • Felix Preisser
  • Emanuele Zaffuto
  • Zhe Tian
  • Derya Tilki
  • Francesco Montorsi
  • Shahrokh F. Shariat
  • Fred Saad
  • Alberto Briganti
  • Pierre I. Karakiewicz
Original Article



No prospective data examined the effect of radical prostatectomy (RP) vs. external beam radiotherapy (EBRT) in locally advanced prostate cancer (PCa). We aimed to compare survival outcomes of RP and EBRT in patients harboring cT3N0-1 PCa.


Within the SEER database (2004–2014), we identified 5500 cT3N0-1 PCa patients. Cumulative incidence plots and competing-risks regression models (CRRs) tested cancer-specific mortality (CSM) and other cause of mortality (OCM) according to treatment type. The multivariable relationship between baseline prostate-specific antigen (PSA) values and 10-year CSM after either RP or EBRT was graphically depicted using the LOESS smoothing method. Sensitivity analyses were performed in cT3N0-only patients, after OCM propensity score matching, and through landmark analyses.


Ten-year CSM and OCM rates were significantly higher after EBRT (15.8 and 28.2%) than RP (8.1 and 10.4%) (all p < 0.0001). In multivariable CRRs, RP yielded lower CSM [hazard ratio (HR): 0.64] than EBRT. Significantly lower 10-year CSM rate was recorded after RP vs. EBRT through the entire range of baseline PSA values. The same results were recorded in cT3N0 subgroup, as well as after OCM propensity score matching. Finally, landmark analyses at 6, 12, 24, and 36 months rejected the effect of favorable survival bias after RP.


CSM was significantly lower after RP than EBRT in cT3N0-1 PCa. A lower CSM was recorded throughout the entire range of baseline PSA and even in cT3N0 subgroup, as well as after OCM propensity score matching and landmark analyses.


Prostate cancer Radical prostatectomy External beam radiotherapy Locally advanced disease SEER program 


Author contribution

MB: protocol/project development, data collection or management, data analysis, manuscript writing/editing. FP: data collection or management. MM: manuscript writing/editing. ZT: data analysis. EZ: manuscript writing/editing. DT: data analysis. FM: protocol/project development. SFS: data collection or management. AB: protocol/project development. FS: manuscript writing/editing. PIK: manuscript writing/editing, protocol/project development.

Compliance with ethical standards

Conflict of interest

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors have stated that they have no conflict of interest.

Supplementary material

345_2018_2310_MOESM1_ESM.tiff (902 kb)
Supplementary Figure 1. Graphical depiction of multivariable adjusted cancer specific mortality rate (LOESS) in 1,866 cT3N0-1 prostate cancer after other cause mortality propensity score matching according to treatment received: radical prostatectomy vs. external beam radiotherapy. 1 (TIFF 902 kb)
345_2018_2310_MOESM2_ESM.tiff (902 kb)
Supplementary Figure 2. Cumulative incidence plots depicting other cause mortality rates in 1,866 cT3N0-1 prostate cancer after other cause mortality propensity score matching stratified according to treatment received: radical prostatectomy vs. external beam radiotherapy. 2 (TIFF 902 kb)
345_2018_2310_MOESM3_ESM.docx (13 kb)
Supplementary material 3 (DOCX 12 kb)
345_2018_2310_MOESM4_ESM.docx (15 kb)
Supplementary material 4 (DOCX 15 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Marco Bandini
    • 1
    • 2
    • 3
    Email author
  • Michele Marchioni
    • 3
    • 4
  • Felix Preisser
    • 3
    • 5
  • Emanuele Zaffuto
    • 1
    • 2
  • Zhe Tian
    • 3
  • Derya Tilki
    • 5
  • Francesco Montorsi
    • 1
    • 2
  • Shahrokh F. Shariat
    • 6
  • Fred Saad
    • 3
  • Alberto Briganti
    • 1
    • 2
  • Pierre I. Karakiewicz
    • 3
  1. 1.Division of Oncology/Unit of Urology URIIRCCS Ospedale San RaffaeleMilanItaly
  2. 2.Vita-Salute San Raffaele UniversityMilanItaly
  3. 3.Cancer Prognostics and Health Outcomes UnitUniversity of Montreal Health CenterMontrealCanada
  4. 4.Department of UrologySS Annunziata Hospital, “G. D’Annunzio” University of ChietiChietiItaly
  5. 5.Martini Klinik, University Medical Center Hamburg-EppendorfHamburgGermany
  6. 6.Department of UrologyMedical University of ViennaViennaAustria

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