ArticleWorld journal of urology2026
EQUIPOISE: EQUivalence In Prostate cancer treatment: surgery Or radiotherapy? An Intention-to-treat Survival analysis from real-world Evidence.
Article in World journal of 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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Abstract
purposeTo 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.
methodsUsing 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.
resultsOf 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.
conclusionsSurgery 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.
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