ReviewTranslational andrology and urology2026
Comparative outcomes of radical prostatectomy, radiotherapy, and radiotherapy plus androgen deprivation therapy for high-risk and very high-risk prostate cancer: a narrative review.
Review in Translational andrology and urology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
4 authors.
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Abstract
Background and Objective: High-risk and very high-risk prostate cancer (PCa) accounts for approximately 15-20% of newly diagnosed cases and are associated with substantial risk of disease progression, metastasis, and cancerspecific mortality. The comparative effectiveness of radical prostatectomy (RP), external beam radiotherapy (EBRT), and radiotherapy combined with androgen deprivation therapy (RT + ADT) remains uncertain because randomized head-to-head trials are lacking. This narrative review aims to synthesize the comparative effectiveness of RP, EBRT, and RT + ADT in patients with high-risk and very high-risk PCa, with respect to survival outcomes, optimal ADT duration, and toxicity/quality-of-life profiles. Methods: Literature searches were conducted across PubMed, Cochrane Library (CENTRAL), and ClinicalTrials.gov through May 2026. Studies comparing RP, EBRT, and/or RT + ADT in patients with high-risk PCa [prostate-specific antigen (PSA) ≥20 ng/mL, Gleason score 8-10/International Society of Urological Pathology (ISUP) grade ≥4, or clinical stage ≥T3a] were included. Primary outcomes were overall survival (OS), prostate cancer-specific survival (PCSS), and biochemical recurrence-free survival (bRFS). Key Content and Findings: Observational studies comparing RP and RT-based strategies have reported conflicting results for OS: some studies reported more favorable outcomes with RP [hazard ratio (HR) 1.60, 95% confidence interval (CI): 1.25-2.05 for EBRT + ADT Conclusions: For patients with high-risk and very high-risk PCa, radiotherapy combined with 18-24 months of ADT is supported by evidence from randomized trials compared with radiotherapy alone. Comparative survival evidence between RP and RT-based strategies remains conflicting and is limited by observational designs and selection bias. Treatment selection should be individualized according to patient age, comorbidity burden, tumor characteristics, and quality-of-life preferences. Randomized trials directly comparing contemporary RP with modern RT + ADT are urgently needed.
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