LOCAL treatment for intermediate-risk prostate cancer was associated with no additional years of life lost compared with matched population controls, whereas patients receiving no local treatment experienced a survival disadvantage. The findings highlight the potential importance of radical prostatectomy or radiotherapy, particularly for younger patients and those with unfavourable disease characteristics.
Researchers analysed data from 220,113 patients aged 45-75 years with intermediate-risk prostate cancer identified in the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2021. Patients were grouped according to whether they underwent radical prostatectomy, received radiotherapy, or had no local treatment.
The study aimed to quantify years of life lost (YLL) by comparing survival estimates for patients with prostate cancer against matched population controls. Individual survival estimates were generated using Monte Carlo simulations and Social Security Administration life tables.
Of the cohort, 94,452 (42.9%) underwent radical prostatectomy, 85,232 (38.7%) received radiotherapy, and 40,429 (18.4%) received no local treatment.
Overall, patients who underwent radical prostatectomy or radiotherapy showed no YLL disadvantage compared with population controls. However, those who received no local treatment experienced an average disadvantage of 0.21 YLL (p<0.001).
Age at diagnosis influenced the findings. Among patients diagnosed between 45 and 55 years, those receiving no local treatment experienced a YLL disadvantage of 1.32 years, while those receiving radiotherapy experienced a disadvantage of 0.69 years. No YLL disadvantage was observed among patients in this age group who underwent radical prostatectomy.
Disease characteristics also affected outcomes. Among patients with unfavourable intermediate-risk prostate cancer, those receiving no local treatment experienced a YLL disadvantage of 0.47 years. No corresponding disadvantage was observed in patients who underwent radical prostatectomy or radiotherapy.
The findings suggest that local treatment may be particularly important for younger patients and those with unfavourable intermediate-risk disease. Both radical prostatectomy and radiotherapy were associated with survival estimates comparable to those of matched population controls across the analysed subgroups.
However, the retrospective study design means the findings demonstrate associations rather than proving that local treatment prevents premature death. Treatment decisions should therefore consider individual disease characteristics and patient circumstances. The results highlight the importance of assessing the potential survival implications of omitting local treatment in intermediate-risk prostate cancer.
Reference
Falkenbach F et al. Local treatment vs. years of life lost in intermediate-risk prostate cancer. World J Urol. 2026;44:774.
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