A combination of surgery and radiation therapy is better at extending the survival of men with locally advanced prostate cancer than radiation therapy plus hormone therapy, but is associated with higher rates of erectile dysfunction and urinary incontinence, a study found.
These are the two combinations recommended for high-risk prostate cancer, but the study also shows that only 30 percent of men are getting them.
The study, “Comparative Effectiveness of Radical Prostatectomy With Adjuvant Radiotherapy Versus Radiotherapy Plus Androgen Deprivation Therapy for Men With Advanced Prostate Cancer,” was published in the journal Cancer.
Despite increased screening availability, nearly one in 10 men will be diagnosed with locally advanced or regionally advanced prostate cancer, a kind of cancer that is growing but has not yet spread to other areas of the body.
These men are at high risk for metastasis and current guidelines recommend they receive a combination treatment that includes either radical prostatectomy (surgical removal of the prostate) followed by radiation therapy, or radiation therapy plus androgen deprivation therapy (a treatment that reduces the levels of male hormones).
But there is no consensus as to which approach is most effective.
So, researchers reviewed the medical records of 13,856 men with locally advanced prostate cancer who were included in the Surveillance, Epidemiology, and End Results (SEER)–Medicare database from 1992 to 2009. Patients were 65 or older and were followed for a median of 14.6 years.
Interestingly, researchers found that half of these patients received single treatment with surgery, radiation, or hormone therapy, rather than a combination therapy. Only 30% of men were receiving any of the recommended combinations, including 6.1% who received the surgery option, and 23.6% who got the radiation plus hormone therapy.
And among those receiving surgery and radiation therapy, 30% also received hormone therapy, researchers said.
Because surgery is seen as a high-risk procedure, with increased risk for urinary incontinence and sexual dysfunction, its use decreased significantly over time, from 9.4% in 1992-1997 to 4% in 2004-2009.
“Prostatectomy is an unpopular treatment,” Grace Lu-Yao, PhD, senior author and associate director of Population Science at the Sidney Kimmel Cancer Center-Jefferson Health, said in a press release. “Our study showed that only six percent of men with high-risk cancer were treated with it.”
Researchers then compared the outcomes of men treated with either surgery and radiation or radiation and hormone therapy. Patients were matched by age, race, and number of other co-occurring diseases to control for factors that could influence their outcomes.
The team found that after 10 years, 88.9% of men who received surgery were still alive, compared to 74.2% of those who received the radiation and hormone therapy. However, consistent with prior reports, more of these patients developed urinary incontinence (49.1% vs. 19.4%) and erectile dysfunction (28.3% vs. 20.4%).
“There’s a lot of debate about whether to remove the whole prostate and follow up with radiation therapy. Or, as a second option, to spare the prostate and treat it using radiation therapy plus hormone-blocking therapy,” said Lu-Yao. “Our study suggests that removing the prostate followed by adjuvant radiotherapy is associated with greater overall survival in men with prostate cancer.”
“These findings should be verified with prospective trial data and suggest the need to include a surgical arm in future trials for men with high-risk prostate cancer,” the researchers concluded.
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