Surgery Better for High-Risk Prostate Cancer

Radical prostatectomy was associated with a higher biochemical recurrence-free survival rate compared with radiotherapy.
Radical prostatectomy was associated with a higher biochemical recurrence-free survival rate compared with radiotherapy.

Radical prostatectomy is associated with better biochemical recurrence (BCR)-free survival compared with radiotherapy among men with high-risk prostate cancer (PCa), according to researchers. Both modalities are associated with similar biochemical recurrence-free survival rates among men with low- or intermediate-risk PCa.

Dong Soo Kim, MD, and colleagues at Kyung Hee University School of Medicine in Seoul, Korea, enrolled 165 PCa patients into a retrospective study and divided them into 2 groups according to National Comprehensive Cancer Network (NCCN) guidelines: a low-intermediate risk group (115 patients) and a high-risk group (50 patients). Of the patients in the low-intermediate risk group, 88 underwent radical prostatectomy (RP) and 27 underwent radiotherapy (RT).

Nine of the RP patients (10.2%) and 3 of the radiotherapy patients (11.1%) experienced BCR, the researchers reported in the Korean Journal of Urology (2015;56:703-709). In the high-risk group, 25 patients underwent RP and 25 underwent radiotherapy. Four of the RP patients (16%) experienced BCR compared with 12 (48%) of the radiotherapy patients.

In the low-intermediate risk group, the 5-year BCR-free survival rates in the RP and radiotherapy patients were 82.2% and 86.6%, respectively, a non-significant difference between the groups. In the high-risk group, the 5-year BCR-free survival rate was 74.2% for the RP patients compared with 27.7% for the radiotherapy patients, a significant difference.

“RP should be a more strongly considered option when deciding the treatment method for selected high risk patients,” the authors wrote.

NCCN guidelines define low-risk PCa patients as those with T1–T2a tumors, Gleason score 6 or less, and a PSA level less than 10 ng/mL; intermediate-risk patients are those with T2b–T2c tumors, a Gleason score 7, or PSA level of 10–20 ng/mL. The guidelines define high-risk patients as those with T3a tumors, Gleason score 8–10, or PSA level greater than 20 ng/mL. The investigators defined BCR in RP patients as a PSA level of 0.2 ng/mL or higher followed by a repeat measurement higher than 0.2 ng/mL or the initiation of salvage treatment. They defined BCR in RT patients as PSA nadir plus 2 ng/mL or the initiation of androgen-deprivation therapy.

The researchers noted that their findings are consistent with those of other studies demonstrating the superiority of RP for treating high-risk PCa. For example, in a systematic review and meta-analysis published in Clinical Genitourinary Cancer (2014;12:215-224), Fausto Petrelli, MD, of Azienda Ospedaliera Treviglio, Treviglio, Bergamo, Italy, and colleagues found that RP was associated with a significant 49% decreased risk of death from any cause, 44% decreased risk of prostate cancer-specific mortality (PCSM), and 47% decreased risk of non-PCSM compared with RT in the treatment of localized high-risk PCa.

In a separate study by Joo Yong Lee, MD, and colleagues at Yonsei University College of Medicine in Seoul, Korea, the 5-year estimated cancer-specific survival rates among men with clinically localized high-risk PCa were significantly higher for men treated with RP than RT (96.5% vs. 88.3%), according to a report in Annals of Surgical Oncology (2014;21:4026-4033).

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