3217 - Assessment of Non-Randomized Comparisons of Radical Prostatectomy vs. Radiation Therapy for Prostate Cancer

12:45pm - 02:00pm PT

Hall F

Screen: 11

POSTER

Presenter(s)

Zakaria El Kouzi, MD - MD Anderson Cancer Center, Houston, TX

Z. El Kouzi¹, R. Kouzy², M. K. Rooney³, J. J. Chen⁴, M. A. Mohammed⁵, Z. Rahman², C. J. Hassanzadeh⁶, and O. Mohamad⁶; ¹Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, ²MD Anderson Cancer Center, Houston, TX, ³Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, ⁴Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA, ⁵American university of Beirut Medial center, Beirut, Lebanon, ⁶Department of Genitourinary Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX

Purpose/Objective(s):

ProtecT was a randomized controlled trial which found that radical prostatectomy (RP) and radiation therapy (RT) offer comparable oncologic outcomes for localized prostate cancer. However, retrospective studies present mixed findings about which treatment might be superior. It is commonly believed that specialists tend to favor the treatment modalities in which they are trained, as reflected in studies authored by members of their own specialty. In this study, we aimed to investigate whether nonrandomized studies favored RP or RT and determine if the specialty of the leading authors —urologists or radiation oncologists— plays a role in shaping conclusions.

Materials/Methods:

We reviewed papers published between 1993 and 2024 comparing surgical and radiation-based therapies for prostate cancer. We included studies which compared RP and RT for localized prostate cancer and reported biochemical control, distant metastasis, or survival outcomes. To determine author specialty, we identified whether the first or senior author was a urologist or a radiation oncologist. Papers in which there was both a urologist and a radiation oncologist as first and/or senior authors were excluded. We then categorized each paper’s conclusion based on whether it favored surgery, radiation, or deemed both treatments equally effective in terms of oncologic outcomes. The potential relationship between author specialty and favored intervention was analyzed using Chi squared test. Statistical analysis was done with software.

Results:

One hundred and five papers were included in the final analysis of which 40% were single-institution retrospective studies, 38% utilized national database analyses, 22% were multi-institutional retrospective studies, and 1% were prospective studies. Nearly two-thirds of the papers had urologists as first or senior authors, while one-third were authored by radiation oncologists. Of all the studies, 40% concluded that neither intervention was superior, 47.6% favored surgery, 12.4% favored radiation. Among the papers that favored surgery, 90% were authored by urologists. Of those that reported no clear preference, 54.7% were led by radiation oncologists. Meanwhile, studies favoring radiation were split between 61.5% urology authors and 38.5% radiation oncology authors (p=0.0001).

Conclusion:

Our analysis suggests that studies led by urologists frequently highlight surgery as the superior option, while those led by radiation oncologists more often present surgical and radiation treatments as having comparable outcomes. More research is needed to understand how these patterns influence decision-making processes for both physicians and patients.

Abstract 3217 - Table 1

Favored Intervention	Authorship		p=0.0001
Favored Intervention	Urology	Radiation Oncology
Surgery	45	5
Radiation	8	5
No Favored Intervention	19	23