Tomoyuki Shimabukuro, Hidekazu Tanaka, Masahiro Tanabe, Takanori Tokunaga, Kosuke Shimizu, Nakanori Fujii, Keita Kobayashi, Toshiya Hiroyoshi, Hiroshi Hirata, Koji Shiraishi
Poorer ECOG performance status and biochemical recurrence were independently associated with worse PCSS in patients with hvPCa. These findings highlight the prognostic importance of patient functional status in addition to conventional tumor-related factors and may contribute to improved risk stratification and individualized treatment selection.
BACKGROUND AND OBJECTIVE: High- and very high-risk prostate cancer (hvPCa) is associated with substantial prostate cancer-specific mortality, making optimal treatment selection challenging. This study reevaluated our 25-year institutional experience with hvPCa to assess long-term oncological outcomes and identify prognostic factors associated with survival.
METHODS: We retrospectively analyzed 220 patients with hvPCa reclassified according to the latest National Comprehensive Cancer Network guidelines. Of these, 66 underwent radical prostatectomy (RP), 52 received radiotherapy plus androgen deprivation therapy (RT + ADT), and 102 received primary ADT. Long-term oncological outcomes were compared across treatment modalities and risk groups. Prognostic factors associated with prostate cancer-specific survival (PCSS) were evaluated using Cox proportional hazards models.
RESULTS: The median age was 71 years, and the median follow-up duration was 88 months. During follow-up, 49 patients (22.3%) died from any cause, and 19 (8.6%) died from prostate cancer. Among high-risk patients, overall survival was significantly better in the RP group than in the ADT group (hazard ratio [HR]: 4.812; 95% confidence interval [CI]: 1.832-12.635; p = 0.001). Among very high-risk patients, PCSS was significantly worse in the ADT group than in the RP group (HR: 2.899; 95% CI: 1.454-5.782; p = 0.003). Multivariable analysis identified ECOG performance status ≥ 2 (HR: 40.756; 95% CI: 1.846-899.767; p = 0.019) and biochemical recurrence (HR: 21.566; 95% CI: 1.079-430.937; p = 0.044) as independent predictors of poorer PCSS.
CONCLUSIONS: Poorer ECOG performance status and biochemical recurrence were independently associated with worse PCSS in patients with hvPCa. These findings highlight the prognostic importance of patient functional status in addition to conventional tumor-related factors and may contribute to improved risk stratification and individualized treatment selection.