High-risk prostate cancer: Surgery also a good treatment option for older men

This study examined outcomes of different treatment options among older men (aged 70 or older) with high-risk prostate cancer. Authors reported lower disease recurrence rates for prostate surgery compared to radiation and radiation with hormone therapy.

Prostate surgery and radiation therapy are both common treatment options for localized prostate cancer. A number of studies have reported good treatment outcomes following prostate surgery among men with increased risk of cancer recurrence (high-risk prostate cancer). High PSA (prostate specific antigens; a protein elevated in the blood in prostate cancer), high tumor stage, and tissue samples indicating aggressive cancer cells (Gleason score of 8 to 10) can each increase cancer recurrence risk.

Radical treatment options, such as surgery, are often not recommended for older men with prostate cancer. This is due to lower life expectancies and the increased likelihood of additional medical conditions. Older men may receive conservative therapies or no therapies at the risk of treatment-related side effects. However, it has been argued that some older men with high-risk prostate cancer may benefit from the survival advantage of surgery. 

This study analyzed the records of 335 older men undergoing treatment for high-risk prostate cancer. All men were aged 70 years or older with 1 of the 3 high-risk factors (high PSA, high tumor stage, or high Gleason score). 34.6% received radiation therapy alone. 49.4% of men received hormone therapy in addition to radiation. 16% of men underwent laparoscopic prostate surgery (multiple small incisions) with local lymph node removal. Treatment outcomes were followed for an average of 40.9 months.

Disease recurrence (based on blood tests) at 3 years was 16.7% in the group treated with surgery. This was significantly lower compared to 51.3% for radiation alone and 30.5% for radiation plus hormone therapy.

44.4% of men undergoing prostate surgery had positive surgical margins (an indication that some cancer cells were left behind). 7 men (13%) required radiation therapy after surgery. Surgical complications of surgery were observed in 5 men (9.3%). These included internal bleeding, artery obstruction in the leg, carbon dioxide retention, and sepsis (bacterial infection in the blood). Most men stayed in the hospital for 2 days. 91% were continent 12 months after prostate surgery.

59.8% of men receiving radiation alone had an inflammation of the rectum and anus. This was similar for men undergoing radiation with hormone therapy. However, most cases were considered mild.

Authors concluded that prostate surgery is a suitable treatment option for older men with high-risk prostate cancer.