Study: Surgery Superior to Radiotherapy in Men with Localized Prostate Cancer
Surgery offers better survival benefit for men with localized prostate cancer, according to a large observational study, conducted by a group of researchers in Sweden and the Netherlands.
The study, “Comparative oncologic effectiveness of radical prostatectomy and radiotherapy in prostate cancer: An analysis of mortality outcomes in 34,515 patients treated with up to 15 years follow-up,” won the second prize for Best Abstract in Oncology at the 28th Annual EAU Congress held in in Milan, March 15-19.
“The current gold standard management of localized prostate cancer is radical therapy, either as surgery or radiation therapy. This study suggests that surgery is likely superior to radiation for the majority of men who have localized prostate cancer, especially the younger age group and those with no or few comorbidities,” said lead author Prasanna Sooriakumaran, MD, PhD, of the Karolinska University Hospital in Stockholm.
Study Details
In their study, Dr. Sooriakumaran and colleagues compared the oncologic effectiveness of radical prostatectomy and radiotherapy in prostate cancer, and analyzed the mortality outcomes in 34,515 patients treated with up to 15 years of follow-up.
Data from Sweden’s National Prostate Cancer Registry showed that the men were treated for prostate cancer throughout Sweden with either surgery (n = 21,533) or radiotherapy (n = 12,982) as their first treatment option and form the study cohort. Patients were categorized by risk group (localized–low risk, localized–intermediate risk, localized–high risk, and nonlocalized–any T3-4, N+, M+, PSA > 50), age (< 65, 65-74, ≥ 75), and Charlson comorbidity index or CCI (0, 1, ≥ 2).
In their results, the researchers said radiotherapy patients generally had higher Gleason sums and clinical stages, were older, and had higher PSA levels than patients who underwent surgery (P < .0001 for all comparisons). Prostate cancer mortality became a larger proportion of overall mortality as risk group increased for both the surgery and radiotherapy cohorts. The study also showed that for patients with localized prostate cancer (risk groups 1-3), survival outcomes favored surgery, whereas for patients with locally advanced/metastatic disease, treatment results were similar.
Next Steps
“This study may herald an increasing use of surgery over radiation in this group. Also, our study concluded that for men with advanced prostate cancer, both modalities appear equivalent, and thus, the conventional view that surgery is not indicated in this group may be incorrect,” explained Dr. Sooriakumaran.
He added that the majority of men with low-risk prostate cancer do not die of the disease.
“A very long follow-up period is needed to make any comments regarding comparative oncologic outcomes between treatments. Hence, the use of active surveillance may be appropriate in men with low-risk disease,” Dr. Sooriakumaran pointed out.
However, men with intermediate- and high-risk disease are at relatively high probability to die from prostate cancer. “Especially when we look at the absolute numbers involved,” he said, adding that radical treatment, preferably in the form of surgery, is warranted if possible.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
