Prostate surgery versus radiation therapy: Mortality rates compared

This study compared treatment outcomes of prostate surgery and external beam radiation therapy (EBRT) for localized prostate cancer. While mortality rates were generally very low, prostate surgery may be more suitable for men with high-risk prostate cancer.

Localized prostate cancer is cancer that is confined to the prostate gland. Surgical removal of the prostate gland and radiation therapy are both common treatments for localized prostate cancer. External beam radiation therapy (EBRT) involves directing high-energy rays from outside the body at the tumor site to kill cancer cells. Advances in prostate surgery as well as EBRT have led to treatments being more efficient and easier to tolerate. Several studies have demonstrated similar treatment effectivity for surgery and EBRT. However, it is not clear whether there are differences in other treatment outcomes, such as mortality rates. 

The aim of this study was to directly compare treatment outcomes following surgery and EBRT.

This study examined the records of 891 men with localized prostate cancer. All men either underwent prostate surgery (569 men) or EBRT (322 men). Men were divided according to risk of cancer recurrence after treatment (low, intermediate, or high). 69.3% of men in the EBRT group and 23.6% in the surgery group received additional hormone therapy. Treatment outcomes were followed for an average of 45 to 53 months.

Overall, 31 men (3.5%) died over the course of the study. The 5-year cancer-specific survival rate (time from treatment until death due to cancer) following surgery was 99.5%. This was significantly higher than the 5-year overall survival associated with EBRT (98.8%). Overall survival (time from treatment until death from any cause) was also significantly higher for prostate surgery. 

There were no deaths recorded among low- or intermediate-risk patients following surgery. There was one intermediate-risk death in the EBRT group. In high-risk patients, overall survival and cancer-specific survival rates were significantly higher following prostate surgery.

5-year cancer recurrence rates (based on blood tests) were lowest among men receiving EBRT, regardless of risk group. 90.9% of men did not show signs of cancer recurrence. In comparison, 81.1% of men undergoing prostate surgery were recurrence-free after 5 years.

The researchers concluded that prostate surgery may be a more suitable choice for high-risk cancer patients. Overall, prostate surgery was associated with better survival rates and EBRT with lower cancer recurrence rates.

Larger trials examining mortality rates over longer periods of time are needed to confirm these results.