Survival after cytoreductive radical prostatectomy versus radiotherapy for non-elderly(< 65 years) bone-metastatic prostate cancer (bmPCa) patients: a propensity matched SEER analysis

Abstract Background: Prostate cancer (PCa) is one of the most prevalent malignancies in men, with bone metastases significantly impacting survival outcomes. Non-elderly patients (<65 years) with bone-metastatic prostate cancer (bmPCa) represent a unique subgroup with potentially more aggressive disease. This study aims to compare the survival outcomes of cytoreductive radical prostatectomy (cRP) versus radiotherapy (RT) in this patient population using a propensity-matched analysis. Methods: Data were extracted from the SEER database (2004–2021), focusing on non-elderly bmPCa patients who underwent either cRP or RT. Propensity score matching (PSM) was applied to balance key covariates between the two treatment groups. The primary outcomes were overall mortality (OM) and cancer-specific mortality (CSM), analyzed using Cox proportional hazards models and Kaplan-Meier survival curves. Results: A total of 3581 patients were included, with 2873 receiving RT and 708 undergoing cRP. After PSM, each group comprised 341 patients. Cox regression analysis revealed that cRP was associated with significantly lower OM (HR 0.69, 95% CI 0.56–0.84, P < 0.001) and CSM (HR 0.62, 95% CI 0.50–0.77, P < 0.001) compared to RT. Subgroup analysis indicated that cRP provided greater survival benefits in patients with lower Gleason scores, lower PSA levels, and N0 staging. Conclusions: In non-elderly bmPCa patients, cRP offers superior survival outcomes compared to RT, particularly in patients with lower disease burden. These findings suggest that cRP should be considered as a primary treatment option in this cohort, although further prospective studies are warranted to confirm these results.