Comparing the outcomes between prostate surgery and different types of radiotherapy in older patients with prostate cancer.

This study compared the outcomes between radical prostatectomy (RP; prostate-removal surgery) and different types of radiotherapy (RT) in older patients with localized prostate cancer (PCa). The study found that RT offers similar cancer-specific outcomes to RP for low- to intermediate-risk patients.

Localized prostate cancer (PCa) is a form of cancer that has not spread beyond the prostate gland. PCa can be treated by surgery, radiation, or hormone therapy. Radical prostatectomy (RP) surgically removes the prostate and the surrounding tissues in patients with PCa.

Radiotherapy (RT) is an effective treatment for PCa. There are many different types of RT used to treat PCa. Brachytherapy (BT) is a type of RT that uses a radioactive implant device into the cancer tissue. It slowly releases radiation and kills cancer cells over time. External beam radiation therapy (EBRT) is another type of RT which involves directing high-energy rays from outside the body at the tumor site to kill cancer cells. Whether RP or RT offers better outcomes in older patients with PCa is still unknown. 

This study involved 65,396 patients aged 70 or older with PCa. 14,057 patients were treated with RP. 37,712 patients were treated with EBRT. 8,383 patients were treated with BT. 5,244 patients were treated with (EBRT plus BT). Patients were followed up for at least 60 months. 

Overall, EBRT was associated with a 69% higher risk of cancer-specific mortality compared to RP. The mortality risk between RP, BT and EBRT plus BT was similar. 

In low- to intermediate-risk PCa, the 10-year mortality risk related to PCa was 1.2% for the RP group, 2.3% for EBRT, 2% for BT, and 1.8% for EBRT plus BT. These differences were not considered significant.

In high-risk patients, EBRT was associated with a higher PCa-related mortality risk than RP. The 10-year risk for mortality due to PCa in patients with high-risk PCa was 7.5% for RP, 10.2% for EBRT, 8.3% for BT, and 7.6% for EBRT plus BT.

This study concluded that EBRT, BT, and EBRT plus BT offer similar cancer-specific outcomes to RP for patients with low- to intermediate risk of PCa. In patients with high-risk diseases, RP is more beneficial than EBRT.

The study did not include information on hormonal therapy. The study did not report data on biochemical-free recurrence, disease-free survival, and metastases. More high-quality trials are needed to confirm these findings.