Comparing treatments for high risk localized prostate cancer

This study aimed to compare radiation therapy with prostate surgery used to treat prostate cancer. It found that prostate surgery had a better overall survival rate. 

Prostate cancer can be treated using surgery or radiation therapy. Radiation therapy can be delivered externally such as external beam radiation therapy (EBRT), or directly into the prostate. This radiation technique that delivers the beam directly into the prostate is called brachytherapy (BT). Brachytherapy can be used with external radiation therapy (EBRT + BT). It is unclear if surgery or EBRT + BT is better to treat high risk localized prostate cancer. 

This study included 13985 patients. 12283 (88%) patients underwent surgery and 1702 (12%) patients had EBRT + BT. Among surgery patients, 15% received additional hormonal therapy. Within the EBRT + BT group, 69% of patients received hormonal therapy. Patients were followed-up for an average of 91 months in the surgery group and 101 months in the radiation group.

Men who had EBRT+ BT had a 22% higher risk of death from all causes including cancer compared to those who had surgery. Young and healthy men with high-risk local prostate cancer were more likely to have longer survival if they had surgery as compared to EBRT + BT. 

This study found that prostate surgery was associated with a better overall survival rate compared to EBRT + BT, for young men with localized high-risk prostate cancer. 

This study was done retrospectively, looking back in time. This is not a good level of evidence. Also, the groups were not equal. The group of prostate surgery was much bigger than the radiation group.