Improved Survival with RP vs. Radiation

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Overall mortality risk is lower with radical surgery than EBRT and brachytherapy.
Overall mortality risk is lower with radical surgery than EBRT and brachytherapy.

SAN FRANCISCO—Radical prostatectomy (RP) is associated with significantly better intermediate-term survival than radiation treatment among men with clinically localized prostate cancer, data suggest.

It also is associated with better cancer-specific survival compared with external beam radiotherapy (EBRT).

The study, led by Andrew Stephenson, MD, of Cleveland Clinic's Glickman Urological & Kidney Institute, and Adam S. Kibel, MD, of Washington University School of Medicine in St. Louis, Mo., included 10,472 patients with localized prostate cancer treated with RP (6,493 patients), EBRT (2,260 patients), and brachytherapy (1,719 patients). The RP patients were significantly younger than the EBRT and brachytherapy patients (60 years vs. 69 and 68 years, respectively).

The investigators used prospensity score analysis to adjust for differences in observed background characteristics. Patients had a median follow-up period of 67 months; 1,550 patients had a median follow-up of more than 10 years.

The overall 10-year survival rates were 87%, 63%, and 60% for the RP, EBRT, and brachytherapy groups, respectively, Dr. Stephenson told listeners. Compared with RP, EBRT and brachytherapy were associated with a significant 1.7 and 1.8 times increased risk of overall mortality, respectively, after adjusting for biopsy Gleason score, comorbidities, age, PSA level, ethnicity, and clinical stage. Patients treated with the two radiotherapies had a significantly higher rate of androgen-deprivation therapy.

EBRT was associated with a significant 1.6 times increased odds of death from prostate cancer. Brachytherapy did not increase prostate cancer mortality risk.

“Physicians and patients should consider these potential differences when choosing among treatment options for localized prostate cancer,” the authors concluded.

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