心脏病死亡风险最近已成为医学界对前列腺癌（PCa）患者关注的焦点。鉴于根治性前列腺切除术（RP）和外照射放射治疗（EBRT）是局部前列腺癌的主要治疗方式，它们对心血管特异性死亡率（CSM）的具体影响仍不清楚。本研究探讨了 RP 和 EBRT 对 CSM 风险的具体影响，以指导临床治疗决策。使用了 SEER 数据库（2010-2015 年）中诊断为 T1-2N0M0 期 PCa 的 45-74 岁患者的数据。应用倾向评分匹配（PSM）、竞争风险回归、COX回归分析和Fine-Gray检验等多变量统计方法评估RP和EBRT对CSM风险的影响。在146,082名T1-2期PCa患者中，心脏疾病成为导致死亡的主要原因，超过了前列腺癌本身。多因素 COX 回归和竞争风险回归分析表明，局部治疗不会增加 CSM 风险。进一步分析显示，与仅接受 RP 的患者相比，仅接受 EBRT 的患者的 CSM 风险显着增加（风险比 [HR] = 2.71，95% 置信区间 [CI] 1.96-3.74，P < 0.001），随后进行 PSM 调整，进一步证实 RP 治疗组的风险显着降低（HR 0.23，95% CI 0.13-0.40，P< 0.001）。T1-2 期 PCa 患者面临显着的 CSM 风险，RP 在降低风险方面比 EBRT 具有潜在优势。这种风险。这些发现鼓励临床医生在制定治疗计划时全面考虑对心脏健康的潜在影响，为优化治疗策略提供重要指导。© 2024。外科肿瘤学会。

The risk of cardiac disease mortality has recently become a focal point of concern within the medical community for patients with prostate cancer (PCa). Given that radical prostatectomy (RP) and external beam radiation therapy (EBRT) are the main treatment modalities for localized PCa, their specific impact on cardiovascular-specific mortality (CSM) remains unclear. This study explored the specific effects of RP and EBRT on CSM risk to guide clinical treatment decisions.Data from patients aged 45-74 years, who were diagnosed with T1-2N0M0 stage PCa from the SEER database (2010-2015), were used. Multivariate statistical methods, including propensity score matching (PSM), competing risk regression, COX regression analysis, and Fine-Gray testing, were applied to assess the impact of RP and EBRT on CSM risk.Among 146,082 T1-2 stage PCa patients, cardiac disease emerged as the primary cause of death, surpassing PCa itself. Multifactorial COX regression and competing risk regression analyses indicated that local treatments do not increase CSM risk. Further analysis revealed a significant increase in CSM risk for patients undergoing only EBRT compared with those undergoing only RP (hazard ratio [HR]  = 2.71, 95% confidence interval [CI] 1.96-3.74, P < 0.001), with subsequent PSM adjustment, further confirming a significantly reduced risk in the RP treatment group (HR 0.23, 95% CI 0.13-0.40, P < 0.001).T1-2 stage PCa patients face a significant risk of CSM, with RP offering a potential advantage over EBRT in reducing this risk. These findings encourage clinicians to comprehensively consider the potential impact on cardiac health when formulating treatment plans, providing crucial guidance for optimizing treatment strategies.© 2024. Society of Surgical Oncology.