Men under age 60 with high-risk prostate cancer who underwent radical prostatectomy — or surgery to remove all or part of the prostate — as an initial treatment showed significantly improved overall survival at four years than those given radiation therapy, a study found.
Researchers used the National Cancer Database to analyze 16,944 high-risk prostate cancer patients, age 59 or younger, who had Gleason scores of 8 to 10 with no metastasis or nodal involvement. The study included data collected between 2004 and 2013.
Of the study population, 12,155 men had radical prostatectomy, and 4,789 had external beam radiation therapy (EBRT) — alone or in combination with brachytherapy — as a first therapy. In 82.5 percent of radiation-treated patients, hormone therapy was also used. Post-operative radiation therapy was given 17.2% of those who had a radical prostatectomy.
After a median 50-month follow-up, statistical modeling was used to determine differences in overall survival between the two groups, and found a significant 48 percent improvement in those who underwent surgery. The estimated survival rate at eight years was also higher in this group, 85.1 percent versus 74.9 percent, respectively.
“When a younger man has high-risk prostate cancer, it generally makes sense to choose surgery over radiation,” David Samadi, a prostate cancer surgeon and urologic oncologist, said in a press release. “Radical prostatectomy has many advantages over radiation which include shorter recovery times, less pain, and from what this study is showing, the prostate cancer is removed with a higher cancer control and survival rate.”
The findings were presented at the 2017 American Society of Clinical Oncology Annual Meeting, which took place in Chicago in early June. The study was published in the Journal of Clinical Oncology, under the title “Survival impact of initial local therapy selection for men under 60 with high risk prostate cancer.”
It concluded: “Compared to RT [radiation therapy], initial treatment of men under 60 with high risk PCa [high-risk prostate cancer] with RP [radical prostatectomy] results in a large, statistically significant improvement in overall survival that remains consistent over time and remains significant in a multivariable model adjusting for known prognostic variables.”
Shortcomings noted by the study’s researchers included its retrospective nature as a database analysis, and a lack of cancer-specific survival information.