Prostatectomy offers best survival rates, except in elderly
MedWire News: Radical prostatectomy offers prostate cancer patients better overall and cancer-specific survival rates than does treatment with radiotherapy or observation, study results show.
However, in high-risk patients aged 70 years and older, and in all patients aged 80 years and older, radiotherapy gives equal or better survival rates than surgery, say the researchers.
Firas Abdollah (University of Montreal Health Center, Quebec, Canada) and colleagues reviewed cancer-specific mortality (CMS) and other-cause mortality (OCM) in 404,604 patients from the Surveillance, Epidemiology, and End Results database.
The team hypothesized that significant CSM and OSM differences would exist according to treatment type, and calculated these after 10 years of follow-up.
Patients were stratified according to treatment type, age category, and prostate cancer risk category, where stage T2c and/or Gleason score 8-10 denoted high risk, and any other stage or Gleason score denoted low-intermediate risk.
A total of 67.2% of the cohort was classed as low-intermediate risk, and the remaining 32.8% as high-risk.
Among the youngest age category (≤59 years), the proportions of men treated with prostatectomy, radiotherapy, and observation were 34.9%, 12.6%, and 9.6%. These proportions were notably different among the eldest men (≥80 years), at 0.9%, 5.7%, and 26.5%, respectively.
The overall 10-year CSM and OSM rates for prostatectomy, radiotherapy, and observation were 3.6%, 6.5%, and 10.8%, and 17.1%, 32.4%, and 48.9%, respectively.
The lowest CSM (1.3-3.7%) and OSM (6.9-31.6%) rates in the low-intermediate risk group were observed among prostatectomy patients, except octogenarians, report Abdollah and team.
They report respective CSM and OSM rates after prostatectomy of 8.9% and 62.8% for men aged 80 years or more, compared with 6.9% and 59.7%, respectively, for radiotherapy.
For high-risk patients, prostatectomy still offered the best survival outcomes among men aged under 69 years, at 5.8-7.2% for CSM, and 8.7-16.1% for OSM. However, radiotherapy offered equal rates to prostatectomy in patients aged 70-79 years, and surpassed prostatectomy success in men aged 80 years or older.
Abdollah et al found that treatment with observation gave the least favorable outcomes among all age- and risk-groups. However, they note that high OCM among observation-treated patients may be a result of their higher rates of comorbidity compared with surgery- or radiotherapy-treated men.
"These findings must be interpreted within the context of the limitations of observational data," concludes the team.
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By Sarah Guy