Surgery Versus Multimodal Radiotherapy for High-Risk Localized Prostate Cancer
Posted: Monday, July 27, 2020
According to research published in Clinical Genitourinary Cancer, long-term survival and quality-of-life outcomes appear to be similar for patients with high- or very high–risk prostate cancer who undergo definitive surgery versus multimodal radiotherapy. However, Jonathan D. Tward, MD, PhD, of the Huntsman Cancer Institute at the University of Utah, Salt Lake City, and colleagues noted that this patient population may be more likely to require multimodal therapy and should be counseled about how this treatment can affect urologic, bowel, sexual, mental, and physical well-being.
The retrospective study included 586 patients who underwent either radical prostatectomy with or without postoperative radiotherapy, external-beam radiotherapy with androgen-deprivation therapy (ADT), or external-beam radiotherapy with ADT plus a brachytherapy boost between 2000 and 2017. At a median follow-up of 5 years and at a threshold of P < .05, no meaningful differences in overall survival or metastasis-free survival were noted. The estimated 5-year metastasis-free survival rates adjusted for propensity were 83.1% for the surgery cohort, 74.6% for the radiotherapy-plus-ADT cohort, and 94.8% for the brachytherapy cohort.
Quality-of-life outcomes differed by treatment group. At a follow-up of 6 months, men in the brachytherapy and surgery cohorts experienced substantially worse mean American Urological Association symptom scores compared with those in the radiotherapy-plus-ADT group, though the disparity was resolved by the 1-year mark. For the first 3 years after treatment, patients in the surgery cohort had superior renal function scores compared with the radiotherapy-plus-ADT group, followed by comparable scores after 3 years. Patients undergoing adjuvant or salvage radiotherapy experienced meaningful decreases in the urinary, sexual, and bowel domains of the Expanded Prostate Cancer Index Composite and in the physical domain of the Veterans RAND 12-Item Health Survey.
Disclosure: For full disclosures of the study authors, visit clinical-genitourinary-cancer.com.