Radical prostatectomy may trump radiotherapy in non-metastatic prostate cancer

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1. Men with localized, non-metastatic prostate cancer who underwent radical prostatectomy demonstrated lower mortality rates compared to treatment with radiotherapy.

2. No treatment advantage between radical prostatectomy versus radiotherapy was observed in metastatic prostate cancer patients.

Evidence Rating Level: 2 (Good)

Study Rundown: Current mainstay treatment for prostate cancer is surgery (radical prostatectomy) and/or radiotherapy. However, trials comparing the effectiveness of surgery versus radiotherapy have been difficult to interpret due to the use of different endpoints and the heterogeneity of disease after biochemical recurrence. The authors of this study analyzed the mortality rates over 34,000 prostate cancer patients treated with either radical prostatectomy or radiotherapy after up to 15 years follow-up. After propensity score matching, patients that underwent radical prostatectomy were found to have significantly decreased prostate cancer mortality compared to radiotherapy in men with locally advanced, non-metastatic prostate cancer. There were no differences found in survival between treatment modalities in metastatic prostate cancer patients. The results of this study suggest that surgery may be the preferred treatment modality in non-metastatic prostate cancer patients. The strength of the study is the large sample size, with 98% completed data collection and the long period of follow-up. However, information regard adjuvant radiotherapy after radical prostatectomy was no available, which may confound the results. Finally, the results may not be generalizable to different ethnic groups given the sample population’s homogenous composition of nearly 100% Caucasian men.

Click to read the study in BMJ

Relevant Reading: Radical prostatectomy versus observation for localized prostate cancer

In-Depth [cohort study]: This study analyzed results from the National Prostate Cancer Registry of Sweden from 1996-2010. 34 515 prostate cancer patients that received either radical prostatectomy or radiotherapy were followed up for survival for up to 15 years (median follow-up time: Surgery: 5.26 years, Radiotherapy: 5.20 years). After propensity score matching, treatment with radical prostatectomy was associated with lower prostate cancer mortality (hazard ratio: 1.76 95%CI: 1.49-2.08; p<0.001) and other causes of death (hazard ratio 1.32, 95%CI: 1.18-1.42; p<0.001) compared to radiotherapy. There were no differences in survival between treatment groups in metastatic prostate cancer patients (hazard ratio 0.76; 95%CI: 0.49-1.19; p=0.081).

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