Survival Advantage for Surgery over Radiotherapy in Non-Metastatic Prostate Cancer

A 15-year observational study suggests men with non-metastatic prostate cancer survive longer if they undergo radical prostatectomy rather than receiving radiotherapy

medwireNews: Radical prostatectomy may be the best treatment option for men with non-metastatic prostate cancer, particularly if they are young, comorbidity free and have intermediate- or high-risk localised disease, study findings indicate.

The hazard ratio (HR) for prostate cancer mortality was a significant 1.76 for radiotherapy versus prostatectomy, the researchers report.

By contrast, there was no significant survival difference between surgery and radiotherapy for men with metastatic prostate cancer, although sensitivity analyses showed a possible benefit of radiotherapy.

“Given the important burden that prostate cancer poses on the National Health Service and healthcare systems worldwide, these findings could have important policy implications for the allocation of resources in the management of this disease,” say the study authors, led by Peter Wiklund, from Karolinska University Hospital in Stockholm, Sweden.

They analysed information on 34,515 men with prostate cancer from the Swedish PCBaSe database, of whom 21,533 underwent surgery and 12,982 received radiotherapy.

Based on the information retrieved, the patients were categorised according to clinical risk – low, intermediate, high or metastatic disease – age and Charlson comorbidity index.

The crude HR for prostate cancer mortality over 15 years of follow-up was 3.09 for radiotherapy versus surgery, which decreased to 1.76 after adjustment for propensity score. Death from causes other than prostate cancer was also higher after radiotherapy than surgery, with a crude HR of 1.77 falling to 1.32 after propensity score adjustment.

The improved survival with surgery was particularly evident for men younger than 65 years old, those with a Charlson score of 0 and men with intermediate- or high-risk prostate cancer.

“[W]e would therefore conclude that for men with non-metastatic prostate cancer where radical treatment is indicated, current collective evidence supports surgery as initial treatment in improving mortality outcomes in younger and fitter men (those with fewer comorbidities) with intermediate or high risk disease who are, at the outset, more likely to die of prostate cancer; older men and those with comorbidities are likely to fare as well, if not better, with upfront radiotherapy,” Peter Wiklund and team write in BMJ.

References

Sooriakumaran P, Nyberg T, Akre O, et al. Comparative effectiveness of radical prostatectomy and radiotherapy in prostate cancer: observational study of mortality outcomes. BMJ 2014 Feb 26;348:g1502. doi: 10.1136/bmj.g1502.

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