Surgery Bests Radiotherapy for Localized Prostate Cancer

Surgery offers superior survival benefit than radiotherapy for men with localized prostate cancer, according to a large observational study.

Researchers at Karolinska University Hospital (Stockholm, Sweden) reviewed data from Sweden's National Prostate Cancer Registry, and analyzed the mortality outcomes in 34,515 patients treated for prostate cancer, with up to 15 years follow-up. In all, 21,533 men received surgical treatment and 12,982 received radiotherapy as their first treatment option. The patients were categorized by risk group (localized- low risk, localized- intermediate risk, localized- high risk, and non-localized- any T3-4, N+, M+, PSA>50), age, and Charlson comorbidity index (CCI).

The results showed that radiotherapy patients generally had higher clinical stages, were older, and had higher PSA than patients that underwent surgery. Prostate cancer mortality (PCM) became a larger proportion of overall mortality as risk group increased for both the surgery and radiotherapy cohorts. The study also showed that for localized prostate cancer patients survival outcomes favored surgery, and for locally advanced/metastatic patients treatment results were similar. The study was presented at the 28th annual congress of the European Association of Urology (EAU), held during March 2013 in Milan (Italy).

“The current gold standard management of localized prostate cancer is radical therapy, either as surgery or radiation therapy,” said lead author and study presenter Prasanna Sooriakumaran, MD, of Karolinska University Hospital. “This study suggests that surgery is likely superior to radiation for the majority of men who have localized prostate cancer, especially the younger age group and those with no or few comorbidities.”

“Also, our study concluded that for men with advanced prostate cancer, both modalities appear equivalent and thus the conventional view that surgery is not indicated in this group may be incorrect,” added Dr. Sooriakumaran. “A very long follow up period is needed to make any comments regarding comparative oncologic outcomes between treatments. Hence, the use of active surveillance may be appropriate in men with low risk disease.”

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