Local treatment vs. years of life lost in intermediate-risk prostate cancer

Purpose The role of radical prostatectomy (RP) or radiotherapy (RT) in intermediate-risk prostate cancer (PCa) is still under debate. Our aim was to quantify the effect of RP and RT on the average years of life lost (YLL) in patients with intermediate-risk PCa. Methods Within the SEER database 2004–2021, intermediate-risk PCa patients aged 45–75 were identified. Stratification rested on local therapy type: RP vs. RT vs. none. We performed Monte Carlo simulation to generate individual survival estimates based on Social Security Administration life tables. Subsequently, YLL was compared between PCa patients and matched population controls. Results Of 220,113 intermediate-risk PCa patients, 94,452 (42.9%), 85,232 (38.7%), and 40,429 (18.4%) underwent RP, RT, and no local therapy, respectively. Compared to population controls, RP and RT patients did not exhibit YLL disadvantages. Conversely, no local therapy patients exhibited a survival disadvantage of 0.21 YLL ( p < 0.001). In the subgroup of patients diagnosed at age 45–55, a YLL disadvantage was seen for no local therapy (1.32) and RT patients (0.69), while their RP counterparts did not exhibit a YLL disadvantage. In further subgroup analyses, a substantial YLL disadvantage was recorded in unfavorable intermediate-risk PCa patients without local therapy (0.47 YLL), whereas no YLL disadvantage was seen in unfavorable intermediate-risk PCa patients who underwent RP or RT. Conclusion In intermediate-risk PCa, no YLL disadvantage was observed in RP and RT patients within all subgroups. Patients diagnosed at a young age and with unfavorable cancer characteristics are at increased risk for premature death if not locally treated. Trial registration doi10.17605 OSF.IO/D2RUV.