Radiotherapy and radical prostatectomy resulted in similar survival outcomes among men with aggressive prostate cancer, according to the results of a comparative analysis published in European Urology.
Currently, international guidelines for aggressive prostate cancer—categorized by a Gleason score of 9-10—recommend radical prostatectomy and external beam radiotherapy with anderogen-deprivation therapy with or without a brachytherapy boost, as acceptable treatment options. However, data comparing these treatment options have produced conflicting accounts about which is best for patients with advanced disease.
Therefore, researchers led by conducted a retrospective analysis of 487 patients with aggressive prostate cancer treated between 2000 and 2014 with external beam radiotherapy (EBRT), extremely-dose escalated radiotherapy (exemplified by EBRT plus brachytherapy), or radical prostatectomy. Kaplan-Meier analysis and multivariate cox regression were used to estimate and compared long-term survival rates of distant metastasis, cancer-specific survival, and overall survival.
After a median follow-up time of 4.6 years, researchers observed that local salvage and systemic salvage were performed more frequently among patients treated with radical prostatectomy compared with EBRT (49% vs 30.1%). However, 5- and 10-year distant metastasis-free survival rates were significantly higher with EBRT plus brachytherapy (94.6% and 89.8%) than EBRT alone (78.7% and 66.7%) and radical prostatectomy (79.1% and 61.5%). The 5- and 10year rates for cancer-specific survival and overall survival were similar, with no significant differences across any of the three cohorts.
Thus, researchers concluded that radiotherapy and radical prostatectomy provide equivalent overall and cancer-specific survival. However, extremely dose-escalated radiotherapy may significantly improve systemic control when compared with either EBRT or radical prostatectomy, which suggests that it, along with anderogen-deprivation therapy, may be the best treatment option for patients with aggressive prostate cancer.
“Our study focuses on a particularly aggressive form of prostate cancer, and provides the largest series of outcomes for patients with this diagnosis who were treated in the modern era,” said Dr Kishan. “Our conclusions are relevant to both physicians advising patients about the effectiveness of different treatment options, and patients who would like to learn more about these options on their own.”
