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Comment & Response
July 24/31, 2018

Optimal Treatment for High-Risk Prostate Cancer—Reply

Author Affiliations
  • 1Department of Radiation Oncology, University of California, Los Angeles
  • 2Department of Epidemiology, University of California, Los Angeles, Fielding School of Public Health
JAMA. 2018;320(4):405. doi:10.1001/jama.2018.6721

In Reply We agree with Dr Ong and colleagues that our multi-institutional retrospective study of outcomes following radical prostatectomy, EBRT, and EBRT+BT for prostate cancer with a Gleason score of 9 to 10 has limitations, as noted in the article. Different time-to-imaging thresholds might explain the observed differences in time to distant metastases but would be less likely to explain the observed differences in prostate cancer–specific mortality.

We analyzed cause-specific Cox regression models comparing outcomes between (1) patients receiving radical prostatectomy with perioperative androgen deprivation therapy vs those receiving EBRT+BT (plus androgen deprivation therapy); and (2) patients receiving radical prostatectomy with postoperative EBRT (in the adjuvant or salvage setting) vs those receiving EBRT+BT (Table). Propensity score adjustment was performed as described previously. The results are consistent with the previously reported outcomes comparing the overall radical prostatectomy cohort vs the EBRT+BT cohort. We acknowledge that these subset analyses are likely to reflect selection biases, which is why we did not previously report them. Additionally, not all patients received androgen deprivation therapy with salvage EBRT; concurrent androgen deprivation therapy may have improved outcomes.1,2 Data on the timing of salvage androgen deprivation therapy after recurrence following any treatment are not available.