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Background <p>Cancer-specific mortality (CSM) rates in patients with rare histological prostate cancer subtypes after treatment with radical prostatectomy (RP) versus radiation therapy (RT) are largely unknown.</p> Methods <p>Relying on the Surveillance, Epidemiology, and End Results database (2004–2020), we identified patients with five prostate cancer subtypes treated with RP or RT. Kaplan–Meier analyses and Cox regression models addressed CSM.</p> Results <p>Of 427,055 patients, 425,692 (99.68%) harbored acinar, 855 (0.20%) ductal, 324 (0.08%) mucinous, 54 (0.01%) signet ring cell adenocarcinoma, and 130 (0.03%) neuroendocrine carcinoma. Of those, 250,910 (59%), 592 (69%), 262 (81%), 34 (63%), and 34 (26%) were treated with RP, respectively. Five-year cancer-specific survival rates after RP versus RT were 99.2 versus 97.1% in acinar; 96.3 versus 87.1% in ductal; 98.7 versus 92.1% in mucinous; 97.0 versus 94.7% in signet ring cell; and 59.4 versus 20.5% in neuroendocrine carcinoma. In univariable Cox regression models, RP was associated with a lower CSM rate in acinar (hazard ratio [HR] 0.28; <i>p </i>&lt; 0.001), ductal (HR 0.25; <i>p </i>&lt; 0.001), and neuroendocrine (HR 0.36; <i>p </i>&lt; 0.001), but not in mucinous (<i>p </i>= 0.052) and signet ring cell carcinoma (<i>p </i>= 0.8). After multivariable adjustment, RP remained an independent predictor of lower CSM in acinar (HR 0.35; <i>p </i>&lt; 0.001), ductal (HR 0.30; <i>p</i> &lt; 0.001), and neuroendocrine carcinoma (HR 0.53; <i>p</i> = 0.042).</p> Conclusions <p>Higher CSM was recorded after RT in acinar, ductal, and neuroendocrine carcinoma. Conversely, no differences in CSM were identified when RP was compared with RT in mucinous and signet ring cell adenocarcinoma.</p>

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Cancer-Specific Mortality in Rare Histological Subtypes of Prostate Cancer: Radical Prostatectomy Versus Radiation Therapy

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月20日

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  • Carolin Siech,
  • Mario de Angelis,
  • Letizia Maria Ippolita Jannello,
  • Francesco Di Bello,
  • Natali Rodriguez Peñaranda,
  • Jordan A. Goyal,
  • Fred Saad,
  • Shahrokh F. Shariat,
  • Salvatore Micali,
  • Nicola Longo,
  • Ottavio de Cobelli,
  • Alberto Briganti,
  • Mike Wenzel,
  • Philipp Mandel,
  • Luis A. Kluth,
  • Felix K. H. Chun,
  • Pierre I. Karakiewicz

摘要

Background

Cancer-specific mortality (CSM) rates in patients with rare histological prostate cancer subtypes after treatment with radical prostatectomy (RP) versus radiation therapy (RT) are largely unknown.

Methods

Relying on the Surveillance, Epidemiology, and End Results database (2004–2020), we identified patients with five prostate cancer subtypes treated with RP or RT. Kaplan–Meier analyses and Cox regression models addressed CSM.

Results

Of 427,055 patients, 425,692 (99.68%) harbored acinar, 855 (0.20%) ductal, 324 (0.08%) mucinous, 54 (0.01%) signet ring cell adenocarcinoma, and 130 (0.03%) neuroendocrine carcinoma. Of those, 250,910 (59%), 592 (69%), 262 (81%), 34 (63%), and 34 (26%) were treated with RP, respectively. Five-year cancer-specific survival rates after RP versus RT were 99.2 versus 97.1% in acinar; 96.3 versus 87.1% in ductal; 98.7 versus 92.1% in mucinous; 97.0 versus 94.7% in signet ring cell; and 59.4 versus 20.5% in neuroendocrine carcinoma. In univariable Cox regression models, RP was associated with a lower CSM rate in acinar (hazard ratio [HR] 0.28; p < 0.001), ductal (HR 0.25; p < 0.001), and neuroendocrine (HR 0.36; p < 0.001), but not in mucinous (p = 0.052) and signet ring cell carcinoma (p = 0.8). After multivariable adjustment, RP remained an independent predictor of lower CSM in acinar (HR 0.35; p < 0.001), ductal (HR 0.30; p < 0.001), and neuroendocrine carcinoma (HR 0.53; p = 0.042).

Conclusions

Higher CSM was recorded after RT in acinar, ductal, and neuroendocrine carcinoma. Conversely, no differences in CSM were identified when RP was compared with RT in mucinous and signet ring cell adenocarcinoma.