In a nutshell
This study examined the effectiveness of various treatment combinations for localized prostate cancer. Researchers concluded that prostate surgery is as effective as radiation therapy, but without the need for additional hormone therapy.
Some background
Surgical removal of the prostate gland and radiation therapy are both common treatments for localized prostate cancer (cancer that is confined to the prostate gland). Brachytherapy is one form of radiation therapy used where a radiation source is placed directly inside the prostate. External beam radiation therapy (EBRT) involves directing high-energy rays from outside the body at the tumor site to kill cancer cells.
A combination of both types of radiation therapy is often recommended in cases where there is a high risk of cancer recurrence. Hormone therapy, such as androgen deprivation therapy (ADT), can also be used in addition to radiation therapy for a more intensive intervention. ADT targets the production of androgens (male sex hormones such as testosterone) and reduces their effect on cancer cell growth. It is not clear whether cancer recurrence is more common following surgery or radiation therapy.
Methods & findings
This study directly compared different treatment combinations for localized prostate cancer. A total of 5,619 men with localized prostate cancer were included in this study. Men received treatment with either prostate surgery or radiation therapy (brachytherapy followed by EBRT). Men undergoing radiation therapy were further divided according to whether or not they received ADT.
5-year overall survival (time from treatment until death from any cause) was 96% among men undergoing prostate surgery. This was significantly higher than in men receiving radiation with ADT (93%) or radiation alone (92%).
5-year cancer recurrence rates (based on blood tests) were lowest among men receiving radiation therapy with ADT. 86% of men in this group did not show recurrence. In comparison, 77% of men undergoing prostate surgery and 74% of men receiving radiation alone did not show cancer recurrence after 5-years.
Tumor stage (stage 2 or higher), a high Gleason score (indicating more aggressive cancer cells), and blood tests showing prostate growth were all risk factors for cancer recurrence. These increased the risk regardless of treatment received.
The bottom line
Researchers concluded that prostate surgery and radiation therapy both offer effective treatment for localized prostate cancer. However, radiation therapy is associated with the need for additional hormone therapy, which can have many side effects.
The fine print
Further studies that randomize treatment allocations are needed to confirm these results.
Published By :
Urologic oncology
Date :
Mar 01, 2016
