Radiotherapy Versus Surgery for High-Risk Localized Prostate Cancer
Posted: Thursday, June 28, 2018
In men with high-risk localized prostate cancer, there appeared to be no significant difference in survival between patients who received brachytherapy-based radiotherapy and those who received radical prostatectomy, according to a study of National Cancer Database data reported by Ronald D. Ennis, MD, of Rutgers Cancer Institute of New Jersey, and colleagues, in the Journal of Clinical Oncology. In their comprehensive study, the investigators adjusted for imbalances in prostate cancer prognostic factors, other medical conditions, and socioeconomic factors.
Because little research exists to guide treatment decisions between radiotherapeutic and surgical options for this patient population, the researchers analyzed the outcomes of 42,765 patients in the National Cancer Database diagnosed between 2004 and 2013. Patients were treated with radical prostatectomy (24,688), external-beam radiotherapy combined with androgen deprivation (15,435), or external-beam radiotherapy plus brachytherapy with or without androgen deprivation (2,642).
Although no significant difference in overall survival was observed for surgery versus radiotherapy with or without androgen deprivation, external-beam radiotherapy plus androgen deprivation was found to be associated with a greater mortality risk than radical prostatectomy. In addition, on sensitivity analysis, Dr. Ennis and colleagues found that external-beam radiotherapy plus androgen deprivation “narrowed the difference, but a significantly higher mortality remained.”
Patients with this type of prostate cancer should seek opinions from both a urologic oncologic surgeon with experience in radical prostatectomy as well as a radiation oncologist with expertise in brachytherapy, the authors recommended. “Some patients might choose treatment primarily on the basis of quality of life as opposed to survival, making all three treatments viable options,” they concluded.