Population-based assessment of treatment patterns for high-risk localized prostate cancer

Authors

  • Christopher J.D. Wallis Division of Urology and Surgical Oncology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada, M5G 2M9
  • Shawn Malone Division of Radiation Oncology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada, K1H 1C4
  • Ilias Cagiannos Division of Urology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada, K1H QC4
  • Robert J. Hamilton Department of Surgery, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada, M5G 2M9
  • Naveen S. Basappa Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada.
  • Cristiano Ferrario Department of Oncology, McGill University, Segal Cancer Centre, Jewish General Hospital, Montreal, QC, Canada, H3T 1E2
  • Geoffrey T. Gotto Department of Surgery, Southern Alberta Institute of Urology, University of Calgary, Calgary, AB, Canada, T2V 1P9
  • Ricardo Fernandes Division of Medical Oncology, London Regional Cancer Program, London, ON, Canada, N6A 5W9
  • Tamim Niazi Radiation Oncology Department, Jewish General Hospital, McGill University, Montreal, QC, Canada, H3T 1E2
  • Christopher Morash The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada, K1H 1C4
  • Ricardo A. Rendon Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS, Canada, B3H 3A7
  • Fred Saad Genitourinary Oncology, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montréal, QC, Canada, H2X 3E4
  • Sebastien J. Hotte Department of Oncology, McMaster University, Juravinski Cancer Centre, Hamilton, ON, Canada, L8V 5C2
  • Eva Sulatycki Medical Affairs, Johnson and Johnson, Toronto, ON, Canada, M3C 1L9
  • Anousheh Zardan Medical Affairs, Johnson and Johnson, Toronto, ON, Canada, M3C 1L9
  • Bobby Shayegan Institute of Urology, St Joseph's Healthcare, McMaster University, Hamilton, ON, Canada, L8N 4A6

DOI:

https://doi.org/10.5489/cuaj.9712

Keywords:

localized prostate cancer, immediate risk, high risk

Abstract

Introduction: High- and very high-risk (H/vHR) localized and locally advanced prostate cancer (LPCa) carry a high burden of distant relapse. In light of emerging data on adjunctive systemic therapy, we aimed to assess present-day, real-world treatment patterns and outcomes among Canadian patients with intermediate-risk (IR) and H/vHR LPCa.

Methods: This retrospective, population-based cohort study identified men aged ≥18 years diagnosed with LPCa between 2010 and 2022 in Ontario, Canada. Patients were stratified into IR and H/vHR groups. Baseline patient characteristics and treatment patterns following LPCa diagnosis were described. Clinical outcomes, including median time to mortality, were assessed using Kaplan-Meier analyses. To better characterize androgen deprivation therapy (ADT) exposure, subgroup analyses were performed in patients aged ≥66 years.

Results: Among 31 571 eligible patients, 18 365 had IR LPCa and 13 206 had H/vHR LPCa. Within one year from diagnosis, patients with H/vHR were more likely to receive definitive therapy (95.4% vs. 81.5%), with shorter durations between diagnosis and treatment (median 72 days vs. 92 days) compared to patients with IR. Patients with H/vHR demonstrated lower median time to mortality (median 4.9 vs. 5.9 years, p<0.0001). Treatment modalities were comparable between cohorts, with external beam radiation therapy (EBRT), radical prostatectomy (RP), and brachytherapy being the most common. Among patients aged ≥66 years, use of ADT post-RP was limited.

Conclusions: Current real-world treatment approaches for H/vHR LPCa emphasize local therapy with surgery and radiotherapy. There are considerable gaps, which may allow improved outcomes through optimized use of systemic therapy.

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Published

2026-10-19

How to Cite

Wallis, C. J., Malone, S., Cagiannos, I., Hamilton, R. J., Basappa, N. S., Ferrario, C., … Shayegan, B. (2026). Population-based assessment of treatment patterns for high-risk localized prostate cancer. Canadian Urological Association Journal, 21(2). https://doi.org/10.5489/cuaj.9712

Issue

Vol. 21 No. 2 (2027): CUAJ February

Section

Original Research

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