Gustavo Viani, Professor at Faculty of Medicine of Botucatu, São Paulo State University (UNESP), shared on LinkedIn:
“Surgery or radiotherapy for prostate cancer: does one really offer a survival advantage.
I am pleased to share the publication of our study, EQUIPOISE, in the World Journal of Urology!
This is a pioneering, large-scale Brazilian population-based study comparing surgery with radiotherapy plus androgen deprivation therapy (ADT) in men with intermediate and high-risk localized prostate cancer.
Using real-world data from the São Paulo Cancer Registry (2014–2023), we analyzed 21,292 patients, including 4,263 matched pairs after propensity-score matching.
What did we find?
- No statistically significant differences in cancer-specific or overall survival after adjustment for patient and disease characteristics.
- The apparent overall survival advantage of surgery in the unadjusted analysis did not persist after matching.
- 20.2% of patients undergoing surgery required additional treatment, increasing to 48.9% among those with lymph node involvement (pN1).
Why does this matter?
For years, observational comparisons have often suggested better survival with surgery.
However, patients selected for radiotherapy are frequently older and have more advanced disease, creating important selection bias.
Our findings highlight how adjusting for these differences can change the interpretation of treatment outcomes.
EQUIPOISE does not establish definitive equivalence between surgery and radiotherapy.
However, it provides important evidence supporting both approaches as valid treatment options and reinforces the importance of shared decision-making.
Beyond the clinical findings, I am particularly proud that this study brings large-scale evidence from Brazil into an international discussion traditionally dominated by North American and European datasets.
Generating high-quality evidence from our own healthcare system is essential to improving cancer care and informing clinical decisions worldwide.
My sincere thanks to my co-authors Ana Carolina Hamamura, Caio Arruda , Carlos E. Cardoso, Helio Salmon, and Gustavo Oliveira do Amaral for their collaboration and commitment to this project.
I would also like to express my appreciation to the University of Vassouras, and the FUSVE Proton Therapy Project for their institutional support and commitment to advancing radiation oncology, clinical research, and innovation in cancer care in Brazil.
This publication represents another step toward our shared goal of integrating clinical practice, scientific research, and technological innovation to improve patient care.”
Title: EQUIPOISE: EQUivalence In Prostate cancer treatment: surgery Or radiotherapy? An Intention-to-treat Survival analysis from real-world Evidence
Authors: Gustavo A. Viani, Ana Carolina Hamamura, Caio Viani Arruda, Carlos E. Cardoso, Helio A. Salmon, Gustavo O. Amaral
You can also read: TRACE-I: Long-Term Outcomes of PSMA-Guided Salvage Surgery in Recurrent Prostate Cancer
