Prostate cancer (PCa) patients who undergo radical prostatectomy have a better prognosis than those who undergo radiation therapy after the development of metastatic disease, researchers reported online ahead of print in European Urology.

Yu-Hsuan Joni Shao, MD, and colleagues at the Cancer Institute of New Jersey in New Brunswick, studied 66 492 men diagnosed with PCa. Of these, 51,337 received radiotherapy (RT), and 15,155 underwent radical prostatectomy (RP) within one year of cancer diagnosis. During the study period, metastatic disease was diagnosed in 2,802 men. In all, 916 men with metastases were included in a propensity-matched cohort. Of these men, 186 died from PCa.

During the follow-up, the adjusted prostate cancer-specific survival (PCSS) after metastasis was 86.2% and 79.3% in the RP and RT groups, respectively, for the low-risk patients. For the intermediate–high-risk patients, the PCSS after metastasis was 76.3% and 63.3% in the RP and RT groups, respectively. RP was associated with a 32% decreased risk of prostate cancer mortality compared with RT among the low-risk patients and a 49% decreased risk in the intermediate–high-risk groups.

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“Our results may have implications for the timing and nature of local PCa treatment,” the authors concluded.

With respect to study limitations, the investigators noted that their study was observational and results may be affected by residual confounders and treatment indication.