Surgery offers long-term survival for patients with aggressive prostate cancer
MedWire News: Radical prostatectomy offers patients with aggressive prostate cancer better long-term survival compared with radiotherapy, US researchers report.
"It's long been believed that patients with aggressive prostate cancer are not candidates for surgery," said Stephen Boorjian (Mayo Clinic, Rochester, Minnesota) who presented the research team's results at the North Central Section of the American Urological Association's 84th Annual Meeting in Chicago, Illinois, this week.
"We found that surgery does provide excellent long-term cancer control for this type of prostate cancer," he added.
The team compared 10-year survival rates in a cohort of 1238 prostatectomy patients and 609 radiotherapy patients with high-risk prostate cancer (prostate-specific antigen level ≥20 ng/ml, biopsy Gleason score 8-10, or clinical stage ≥T3) treated between 1988 and 2004.
Some of the radiotherapy patients (n=344) underwent concurrent androgen deprivation therapy.
After a median follow-up of 10.2 years for prostatectomy, 6.0 years for radiotherapy plus hormone therapy, and 7.3 years for radiotherapy patients, the respective 10-year cancer-specific survival rates were 92%, 92%, and 88%, say Boporjian et al.
However, overall survival rates were significantly better at 10 years for patients who had undergone surgery compared with those who received radiation plus hormones or radiotherapy alone, at 77% versus 67% and 52%, respectively.
The researchers conducted a multivariate analysis to assess patients' risk for systemic disease progression and prostate cancer-specific death. After adjusting for factors including patient age, comorbidities, and tumor characteristics, the team found that treatment with radiotherapy alone was associated with a significant 1.56-fold increased risk for systemic disease progression compared with surgery.
Furthermore, radiotherapy alone was associated with a 2.22-fold increased risk for death from prostate cancer compared with prostatectomy.
No significant differences were observed in the risk for systemic progression (hazard ratio=0.71) or prostate cancer death (hazard ratio=1.02) between patients treated with radiotherapy plus hormones or surgery.
"We want to stress that surgery provides excellent long-term control for high-risk prostate cancer patients," said Boorjian.
And, despite providing comparable survival rates among radiotherapy patients, he added that limiting the need for adjuvant hormonal therapy "may avoid adverse health consequences" associated with hormone treatment.
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By Sarah Guy