ObjectivesTo investigate long‐term disease trajectories among men with high‐risk localized or locally advanced prostate cancer (HRLPC) treated with radical radiotherapy (RT) or radical prostatectomy (RP).Material and MethodsMen diagnosed with HRLPC in 2006–2020, who received primary RT or RP, were identified from the Prostate Cancer data Base Sweden (PCBaSe) 5.0. Follow‐up ended on 30 June 2021. Treatment trajectories and risk of death from prostate cancer (PCa) or other causes were assessed by competing risk analyses using cumulative incidence for each event.ResultsIn total, 8317 men received RT and 4923 men underwent RP. The median (interquartile range) follow‐up was 6.2 (3.6–9.5) years. After RT, the 10‐year risk of PCa‐related death was 0.13 (95% confidence interval [CI] 0.12–0.14) and the risk of death from all causes was 0.32 (95% CI 0.31–0.34). After RP, the 10‐year risk of PCa‐related death was 0.09 (95% CI 0.08–0.10) and the risk of death from all causes was 0.19 (95% CI 0.18–0.21). The 10‐year risks of androgen deprivation therapy (ADT) as secondary treatment were 0.42 (95% CI 0.41–0.44) and 0.21 (95% CI 0.20–0.23) after RT and RP, respectively. Among men who received ADT as secondary treatment, the risk of PCa‐related death at 10 years after initiation of ADT was 0.33 (95% CI 030–0.36) after RT and 0.27 (95% CI 0.24–0.30) after RP.ConclusionApproximately one in 10 men with HRLPC who received primary RT or RP had died from PCa 10 years after diagnosis. Approximately one in three men who received secondary ADT, an indication of PCa progression, died from PCa 10 years after the start of ADT. Early identification and aggressive treatment of men with high risk of progression after radical treatment are warranted.

中文翻译：

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高危前列腺癌根治性治疗后疾病轨迹的人群研究

目的 调查接受根治性放疗 (RT) 或根治性前列腺切除术 (RP) 治疗的高危局限性或局部晚期前列腺癌 (HRLPC) 男性的长期疾病轨迹。 材料和方法 2006 年至 2020 年诊断为 HRLPC 并接受初次治疗的男性RT 或 RP，是从瑞典前列腺癌数据库 (PCBaSe) 5.0 中确定的。随访于 2021 年 6 月 30 日结束。使用每个事件的累积发生率，通过竞争风险分析来评估治疗轨迹和前列腺癌 (PCa) 或其他原因导致的死亡风险。结果总共有 8317 名男性接受了 RT，4923 名男性接受了 RP。中位随访时间（四分位距）为 6.2（3.6-9.5）年。 RT 后，PCa 相关死亡的 10 年风险为 0.13（95% 置信区间 [CI] 0.12-0.14），全因死亡风险为 0.32（95% CI 0.31-0.34）。 RP后，10年PCa相关死亡风险为0.09（95% CI 0.08-0.10），全因死亡风险为0.19（95% CI 0.18-0.21）。 RT 和 RP 后，雄激素剥夺疗法 (ADT) 作为辅助治疗的 10 年风险分别为 0.42 (95% CI 0.41–0.44) 和 0.21 (95% CI 0.20–0.23)。在接受 ADT 作为二级治疗的男性中，开始 ADT 后 10 年，RT 后 PCa 相关死亡风险为 0.33 (95% CI 030–0.36)，RP 后为 0.27 (95% CI 0.24–0.30)。结论大约为 1 10 名接受初次 RT 或 RP 的 HRLPC 男性在诊断 10 年后死于 PCa。大约三分之一接受二次 ADT（PCa 进展的指征）的男性在 ADT 开始 10 年后死于 PCa。有必要对根治性治疗后病情进展高风险的男性进行早期识别和积极治疗。