10-Year Survival of Young Low- and Intermediate-risk Prostate Cancer Patients Better with Radiation than Surgery

10-Year Survival of Young Low- and Intermediate-risk Prostate Cancer Patients Better with Radiation than Surgery

Radiation therapy approaches — including brachytherapy and external beam radiation therapy (EBRT) — lead to better 10-year survival rates than prostate surgery in young patients with low- and intermediate-risk prostate cancer, a study shows.

The research, “Brachytherapy Improves 10-year Overall Survival Compared to Prostatectomy Alone in Young Men (≤60) with Low- and Intermediate-Risk Prostate Cancer: An NCDB Analysis,” was presented at the American Society for Radiation Oncology (ASTRO) 2018 Annual Meeting, in October in San Antonio, Texas.

The treatment of choice for men with localized prostate cancer largely depends on the likelihood that the cancer will get worse. Using measures of cancer aggressiveness, clinical stage, and PSA levels, doctors usually group men into categories of low, intermediate, or high risk of cancer progression and adjust treatment accordingly.

Studies that determine which treatment is more suited for each risk group, however, have not taken into account patients’ age, which is known to affect how well they respond to certain treatments.

Researchers at New York Presbyterian Brooklyn Methodist Hospital aimed to compare the survival outcomes of young prostate cancer patients (ages 18-60) receiving surgery or radiation.

The team examined men whose cancer had not spread and who had been offered prostatectomy — a surgical procedure where all or part of the prostate is removed — external beam radiation (EBRT) alone, brachytherapy alone, or a combination of EBRT and brachytherapy.

In EBRT, high-energy radiation beams are delivered into tumors, accounting for their contours. This is better than traditional radiation treatments, as it limits damage to healthy tissue and nearby organs.

Brachytherapy consists of small radiation seeds implanted directly into tumors. This internal radiation therapy, which can be implanted temporarily or permanently, allows the use of higher total radiation doses delivered in shorter periods than EBRT.

The study included 128,399 patients from the National Cancer Database who had been treated between 2004 and 2014. Among them, 35.4% had a low risk of progression, 39.9% were in the intermediate risk group, and 19.1% had a high risk.

Overall, patients who had a prostatectomy showed better long-term survival rates, compared with those given any type of radiation. But after stratifying patients according to their risk scores, low-risk patients had significantly better 10-year survival rates when given brachytherapy (93%) compared with surgery (91.7%).

Similarly, more patients receiving a combination of EBRT plus brachytherapy lived 10 years or longer (91.4%), compared to 85.8% of those who received surgery.

For those at a high risk of progression, however, the 10-year overall survival rate was similar regardless of whether they received surgery or brachytherapy.

“Based on this [National Cancer Database] analysis, [brachytherapy] as monotherapy in low-risk and along with EBRT in intermediate-risk improves 10-year [overall survival] compared to prostatectomy alone in young men (≤60),” researchers concluded.