Objective:

Compare cancer-specific and overall survival after initial surgery versus radiotherapy plus androgen deprivation therapy (RT + ADT) for men with intermediate- or high-risk localized prostate cancer in São Paulo, Brazil.

Approach:

• Design and data: Retrospective cohort study using the São Paulo Hospital-Based Cancer Registry; men diagnosed from 2014–2023 were classified by their initial treatment strategy.
• Analysis: Propensity-score matching adjusted for measured demographic, tumour, care-setting, and facility factors. Cancer-specific survival accounted for competing mortality; overall survival was also assessed.

Key Findings:

• The intention-to-treat cohort included 21,292 men: 15,735 initially treated with surgery and 5,557 with RT + ADT.
• Median follow-up was 3.4 years; 619 prostate-cancer deaths and 1,923 deaths from any cause occurred.
• Before matching, RT + ADT recipients were older and had more high-risk disease and greater comorbidity-related treatment-setting differences; all measured baseline covariates were imbalanced.
• In the surgical group, 20.2% received at least one additional treatment modality.

Interpretation:

The provided context describes the study design and cohort but does not report matched survival estimates or comparative survival results.

Limitations:

• The retrospective observational design is vulnerable to residual confounding despite adjustment.
• Radiotherapy dose and technique were not recorded.
• Because only first-course treatment was captured, later salvage treatment was incompletely recorded.
• Median follow-up was 3.4 years, and survival estimates were truncated at 8 years.

Sources:

• Article context supplied by the user