Local treatment vs. years of life lost in intermediate-risk prostate cancer.
18 affiliations
- 1Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC, Canada. [email protected].
- 2Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. [email protected].
- 3Department of Urology, University Hospital Heidelberg, Heidelberg, Germany. [email protected].
- 4Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC, Canada.
- 5Vita-Salute San Raffaele University, Milan, Italy.
- 6Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy.
- 7Department of Oncology and Haemato-Oncology, Università degli Studi di Milano, Milan, Italy.
- 8Department of Urology, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany.
- 9Department of Urology, University of Bologna, St. Orsola-Malpighi Hospital, Bologna, Italy.
- 10Division of Urology, Department of Translational Medicine, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy.
- 11Division of Urology, Department of Oncology, University of Turin, Orbassano, Italy.
- 12Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy.
- 13Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
- 14Department of Urology, Weill Cornell Medical College, New York, NY, USA.
- 15Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
- 16Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan.
- 17Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
- 18Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Abstract
Purpose
The role of radical prostatectomy (RP) or radiotherapy (RT) in intermediate-risk prostate cancer (PCa) is still under debate. Our aim was to quantify the effect of RP and RT on the average years of life lost (YLL) in patients with intermediate-risk PCa.Methods
Within the SEER database 2004-2021, intermediate-risk PCa patients aged 45-75 were identified. Stratification rested on local therapy type: RP vs. RT vs. none. We performed Monte Carlo simulation to generate individual survival estimates based on Social Security Administration life tables. Subsequently, YLL was compared between PCa patients and matched population controls.Results
Of 220,113 intermediate-risk PCa patients, 94,452 (42.9%), 85,232 (38.7%), and 40,429 (18.4%) underwent RP, RT, and no local therapy, respectively. Compared to population controls, RP and RT patients did not exhibit YLL disadvantages. Conversely, no local therapy patients exhibited a survival disadvantage of 0.21 YLL (p < 0.001). In the subgroup of patients diagnosed at age 45-55, a YLL disadvantage was seen for no local therapy (1.32) and RT patients (0.69), while their RP counterparts did not exhibit a YLL disadvantage. In further subgroup analyses, a substantial YLL disadvantage was recorded in unfavorable intermediate-risk PCa patients without local therapy (0.47 YLL), whereas no YLL disadvantage was seen in unfavorable intermediate-risk PCa patients who underwent RP or RT.Conclusion
In intermediate-risk PCa, no YLL disadvantage was observed in RP and RT patients within all subgroups. Patients diagnosed at a young age and with unfavorable cancer characteristics are at increased risk for premature death if not locally treated.Trial registration
doi10.17605 OSF.IO/D2RUV.
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BibTeX
@article{falkenbach2026local,
title = {{Local treatment vs. years of life lost in intermediate-risk prostate cancer.}},
author = {Fabian Falkenbach and Mattia Longoni and Andrea Marmiroli and Quynh Chi Le and Calogero Catanzaro and Michele Nicolazzini and Federico Polverino and Jordan A Goyal and Riccardo Schiavina and Carlotta Palumbo and Gennaro Musi and Felix K H Chun and Alberto Briganti and Fred Saad and Shahrokh F Shariat and Lars Budäus and Markus Graefen and Pierre I Karakiewicz},
journal = {World journal of urology},
year = {2026},
month = oct,
doi = {10.1007/s00345-026-06858-4},
url = {https://europepmc.org/article/MED/42961521},
note = {CC BY},
}
RIS
TY - JOUR
TI - Local treatment vs. years of life lost in intermediate-risk prostate cancer.
AU - Fabian Falkenbach
AU - Mattia Longoni
AU - Andrea Marmiroli
AU - Quynh Chi Le
AU - Calogero Catanzaro
AU - Michele Nicolazzini
AU - Federico Polverino
AU - Jordan A Goyal
AU - Riccardo Schiavina
AU - Carlotta Palumbo
AU - Gennaro Musi
AU - Felix K H Chun
AU - Alberto Briganti
AU - Fred Saad
AU - Shahrokh F Shariat
AU - Lars Budäus
AU - Markus Graefen
AU - Pierre I Karakiewicz
PY - 2026
DA - 2026/10/30
JO - World journal of urology
DO - 10.1007/s00345-026-06858-4
UR - https://europepmc.org/article/MED/42961521
AB - Purpose The role of radical prostatectomy (RP) or radiotherapy (RT) in intermediate-risk prostate cancer (PCa) is still under debate. Our aim was to quantify the effect of RP and RT on the average years of life lost (YLL) in patients with intermediate-risk PCa.Methods Within the SEER database 2004-2021, intermediate-risk PCa patients aged 45-75 were identified. Stratification rested on local therapy type: RP vs. RT vs. none. We performed Monte Carlo simulation to generate individual survival estimates based on Social Security Administration life tables. Subsequently, YLL was compared between PCa patients and matched population controls.Results Of 220,113 intermediate-risk PCa patients, 94,452 (42.9%), 85,232 (38.7%), and 40,429 (18.4%) underwent RP, RT, and no local therapy, respectively. Compared to population controls, RP and RT patients did not exhibit YLL disadvantages. Conversely, no local therapy patients exhibited a survival disadvantage of 0.21 YLL (p < 0.001). In the subgroup of patients diagnosed at age 45-55, a YLL disadvantage was seen for no local therapy (1.32) and RT patients (0.69), while their RP counterparts did not exhibit a YLL disadvantage. In further subgroup analyses, a substantial YLL disadvantage was recorded in unfavorable intermediate-risk PCa patients without local therapy (0.47 YLL), whereas no YLL disadvantage was seen in unfavorable intermediate-risk PCa patients who underwent RP or RT.Conclusion In intermediate-risk PCa, no YLL disadvantage was observed in RP and RT patients within all subgroups. Patients diagnosed at a young age and with unfavorable cancer characteristics are at increased risk for premature death if not locally treated.Trial registration doi10.17605 OSF.IO/D2RUV.
SN - 0724-4983
SN - 1433-8726
ER -