Higher survival seen with prostatectomy than EBRT, hormonal therapy

Surgery for localized prostate cancer offers a significantly higher survival rate than either external beam radiation or hormonal therapies, researchers from the University of California, San Francisco recently reported.

The differences among therapies were more prominent at higher levels of cancer risk and suggest that, in many cases, prostatectomy should play a greater role in treatment strategies for patients with prostate cancer that is likely to recur or spread, the researchers say.

Because no adequate randomized trials have compared active treatments for localized prostate cancer, the authors analyzed risk-adjusted, cancer-specific mortality outcomes among men who underwent radical prostatectomy, external beam radiation therapy, or primary androgen deprivation.

For the study, which was published online in Cancer (Aug. 5, 2010), the researchers analyzed data from 7,538 men with localized disease from the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry. Lead author Matthew R. Cooperberg, MD, MPH, and colleagues then compared outcomes across treatments after adjusting for risk and age. In total, 266 men died of prostate cancer during follow-up.

The team found that the risk for cancer-specific mortality was more than three times higher in patients who received hormone therapy versus radical prostatectomy and more than twice as high in patients who received external-beam radiation therapy versus prostatectomy.For men at low levels of risk, prostate cancer mortality was very uncommon, and differences among the treatment options were small. The survival differences increased substantially for men at intermediate and high risk, according to the analysis, with the greatest relative benefit for surgery seen for men at higher levels of risk.

"This is a clear signal to the physician community that prostatectomy should be considered for men with higher-risk prostate cancer," said senior author Peter R. Carroll, MD, of the University of California, San Francisco. "In many cases, surgery would be part of a multimodal treatment approach, including adjuvant radiation or systemic treatments based on the pathology and early PSA response."