Comparing prostate surgery with radiotherapy and radiotherapy with androgen deprivation therapy for advanced prostate cancer

This study aimed to investigate the long-term effects of two treatment combinations for advanced prostate cancer. This study found that surgery and radiotherapy had improved overall survival in comparison with radiotherapy plus androgen deprivation therapy (ADT) in these patients, but with higher rates of side-effects.

Locally advanced prostate cancer (LAPC) can be treated using surgery or radiotherapy. Androgen deprivation therapy (ADT) can also be used. This treatment blocks the production of male hormones, such as testosterone, responsible for cancer growth. However, these therapies can fail and other treatments might be necessary.

Surgery can be used followed by radiotherapy. Radiotherapy can also be used with ADT. It is unclear which option leads to the best long-term results in patients with LAPC.

13,856 men older than 65 with LAPC were included in this study. 6.1% received prostate surgery with radiotherapy. 23.6% received radiotherapy with ADT. Patients were followed up for an average of 14.6 years. 

Men who had prostate surgery with radiotherapy had better 10-year overall survival, compared to those who had radiotherapy with ADT. Men who received surgery with radiotherapy had a more than 2-times lower risk of dying from prostate cancer compared to those treated with radiotherapy and ADT.

However, men who had prostate surgery and radiotherapy had more side effects such as erectile dysfunction (28.3% vs 20.4%) and urinary incontinence (involuntary leakage of urine; 49.1% vs. 19.4%) compared to those treated with radiotherapy with ADT.

This study found that surgery followed by radiotherapy had better outcomes in comparison with radiotherapy plus ADT in men with LAPC, but was associated with higher rates of side-effects. 

Patients included in this study received different doses of radiotherapy. This might have affected the outcomes.