EQUIPOISE: EQUivalence In Prostate cancer treatment: surgery Or radiotherapy? An Intention-to-treat Survival analysis from real-world Evidence - Scorecard - MDSpire
Clinical Scorecard: EQUIPOISE: Real-World Intention-to-Treat Survival Analysis Comparing Surgery and Radiotherapy for Prostate Cancer
At a Glance
Category
Detail
Condition
Clinical topic addressed by the source article: EQUIPOISE
Key Mechanisms
The study compares initial radical prostatectomy with external radiotherapy plus androgen deprivation using an intention-to-treat framework and assesses cancer-specific and overall survival.
Target Population
Population described in the source article.
Care Setting
Statewide hospital-based cancer registry cohort in São Paulo, Brazil.
Key Highlights
This retrospective cohort included 21,292 men: 15,735 initially treated with surgery and 5,557 with RT + ADT.
The primary endpoint was cancer-specific survival; overall survival was the secondary endpoint.
Median follow-up was 3.4 years; 619 prostate-cancer deaths and 1,923 deaths from all causes were recorded.
Before matching, treatment groups differed substantially in age, disease risk, PSA, Gleason score, care system, and facility type.
In the surgical arm, prostatectomy was the sole treatment for most patients; 20.2% received at least one further modality.
Guideline-Based Recommendations
Diagnosis
The study classified risk using clinical T category, PSA band, and Gleason band in a simplified three-tier, D’Amico-like scheme.
High risk was defined by any of cT3–T4, PSA ≥20 ng/mL, or Gleason ≥8; low risk required cT1–T2a, PSA <10 ng/mL, and Gleason ≤6; all others were intermediate risk.
Management
Guidelines endorse radical prostatectomy and radiotherapy combined with androgen deprivation as curative treatments for clinically localized intermediate- and high-risk disease.
Monitoring & Follow-up
Risks
The source notes that observational comparisons may be affected by confounding by indication; radiotherapy recipients are generally older and more comorbid.
The source notes that surgery-based care may include later radiotherapy and androgen deprivation, which crude treatment labels can conceal.
Late salvage treatment was incompletely captured because registry recording was limited to the first treatment course.
Patient & Prescribing Data
Men with intermediate- or high-risk localized prostate cancer diagnosed in São Paulo from 2014 to 2023 and initially treated with surgery or RT + ADT; low-risk cases were excluded from adjusted analyses.
The cohort included 15,735 men initially treated with surgery and 5,557 receiving RT + ADT. RT + ADT recipients had a higher median age than surgery recipients (71 vs 64 years) and a greater proportion of high-risk disease (54.8% vs 38.5%).
Clinical Best Practices
Interpret unadjusted comparisons cautiously because treatment groups differed substantially at baseline.
The study used 1:1 propensity-score matching without replacement, a 0.2-standard-deviation caliper, and standardized mean differences to assess balance; less than 0.10 was considered adequate.
The intention-to-treat approach retained patients who received post-prostatectomy treatment in the surgery group.
The authors describe the reported proportions receiving later salvage therapy as lower bounds because late treatment was incompletely recorded.
