Examining surgery as a primary treatment for high-risk prostate cancer

This study examined evidence for the role of prostate surgery in treating high-risk prostate cancer. Authors concluded that surgery is an effective primary treatment option for men with high-risk disease.

Localized prostate cancer is cancer that is confined to the prostate gland. Men with high-risk localized prostate cancer are at increased risk of disease recurrence after treatment. Most definitions of high-risk disease include tumor stage, PSA levels (prostate specific antigen; a protein elevated in the blood in prostate cancer), and Gleason score (the aggressiveness of cancer cells).

Intensive treatment is often needed early on. Hormone therapy has often been recommended, which can be combined with local treatments such as radiation or surgery. Increasing evidence is suggesting a role for surgery as a primary therapy for high-risk disease.

The aim of this study was to review evidence on the role of prostate surgery in treating high-risk prostate cancer.

One study reported treatment outcomes for men with high-risk disease treated with surgery alone. Cancer-specific survival (rate of patients who did not die from prostate cancer) was 85% at 10 years and 76% at 15 years. About a quarter of patients were downstaged from a tumor stage 3 to a tumor stage 2. A similar study noted that 31% of men with high-risk disease were downgraded to having less aggressive cancer cells (from a Gleason score of 8 to a Gleason score of 7 or less) after treatment with surgery alone.

A study involving 12,000 prostate cancer patients including 1,900 men with high-risk disease reported a 10-year mortality rate due to cancer of 8% following surgery. This was 19% at 15 years. In a separate study cancer-specific survival at 20 years was 81%. 42% of men did not undergo any additional treatment before or after surgery.

PSA values before surgery were found to affect cancer-specific survival at 10 years for men with high-risk disease. It was 90% for men with PSA levels between 50 and 99 ng/ml and 79% for men with PSA levels higher than 100 ng/ml. In another study, authors analyzed the records of 2,065 men with high-risk disease treated with surgery alone. At 5 years, 55.2% of men were recurrence-free (based on blood tests). They also found that for men with Gleason scores of 8 to 10, the longer the time since surgery, the lower the risk of recurrence. For men with a tumor stage of 3 or higher, the risk remained stable over time.

In a recent analysis of 19 studies, increased mortality risks were noted in patients undergoing radiation compared to surgery. Mortality from any cause was increased by 63%. Cancer-specific mortality was 2.08 times higher with radiation than with surgery.

Authors concluded that surgery is a good treatment option for men with high-risk prostate cancer. Surgery can be effective when used as a primary therapy or when combined with other treatments.

Discuss with your physician if prostate surgery is a treatment option for you.