World journal of urology
October 15, 2026 · via Europe PMC
EQUIPOISE: EQUivalence In Prostate cancer treatment: surgery Or radiotherapy? An Intention-to-treat Survival analysis from real-world Evidence.
Viani GA, Hamamura AC, Arruda CV, Cardoso CE, Salmon HA, Amaral GO.
AI summary — for doctors, generated from the abstract only
In a Brazilian real-world registry, surgery and radiotherapy plus androgen deprivation gave similar cancer-specific and overall survival for intermediate- and high-risk localized prostate cancer after matching.
What was studied
Registry study (São Paulo, diagnoses 2014-2023) of 21,292 men with intermediate- or high-risk localized prostate cancer, comparing initial surgery versus RT + ADT by intention-to-treat with 1:1 propensity matching (4263 pairs).
Key findings
- Cancer-specific survival did not differ (HR 0.87, 95% CI 0.58-1.29 intermediate; 1.00, 95% CI 0.78-1.27 high)
- Five-year CSS was 98.0% vs 96.6% (intermediate) and 94.9% vs 92.9% (high) for surgery versus RT + ADT
- The crude overall survival advantage of surgery did not persist after matching (p = 0.10; p = 0.33)
- Additional therapy was given to 20.2% of operated men, rising to 48.9% in pN1 disease
Clinical relevance
Both strategies can be presented as reasonable alternatives in shared decision-making, remembering that surgery often leads to multimodal treatment.
Who should care
Limitations
Observational registry data with residual confounding despite matching, and relatively short follow-up for prostate cancer.
No survival difference was found after adjustment, supporting patient-preference-based choice.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Purpose
To compare cancer-specific and overall survival between a surgery-based strategy and radiotherapy plus androgen deprivation (RT + ADT) in intermediate- and high-risk localized prostate cancer, using contemporary real-world data from a Latin American public health system.
Methods
Using the state-wide cancer registry of São Paulo, Brazil, we studied men with intermediate- or high-risk localized prostate cancer diagnosed in 2014-2023. Treatment was assigned by initial modality (intention-to-treat). The primary outcome was cancer-specific survival (CSS), with overall survival (OS) secondary. Groups were compared after 1:1 propensity-score matching, with weighting and per-protocol sensitivity analyses.
Results
Of 21,292 patients, matching yielded 4263 pairs (all standardized mean differences below 0.10). CSS did not differ between RT + ADT and surgery [hazard ratio 0.87, 95% CI 0.58-1.29, p = 0.48 (intermediate); 1.00, 95% CI 0.78-1.27, p = 0.98 (high)]. At 5 years, CSS with surgery versus RT + ADT was 98.0% versus 96.6% (intermediate) and 94.9% versus 92.9% (high); OS was 92.6% versus 84.6% and 87.5% versus 82.7%. The crude OS advantage of surgery did not persist after matching (p = 0.10; p = 0.33). Additional therapy was given to 20.2% of operated men, rising to 48.9% in pN1 disease.
Conclusions
Surgery and RT + ADT showed similar cancer-specific and overall survival after adjustment, and surgery frequently entailed multimodal therapy. Both can be presented as alternative therapeutic options in shared decision-making.
DOI
10.1007/s00345-026-06811-5
PMID
42878878
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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