Men younger than 60 years with high-risk prostate cancer (PCa) have better overall survival when their initial treatment is radical prostatectomy (RP) rather than radiation (RT), according to researchers at the 2017 American Society of Clinical Oncology (ASCO) annual meeting.
“The results should be viewed as hypothesis-generating rather than definitive,” Dr Kaiser told Renal & Urology News. “Patients undergoing surgery are afforded postsurgical pathological analysis and therefore may be offered additional or multimodal therapy, including adjuvant or salvage radiation, when adverse risk factors are noted. Or patients in the radiation group may have been understaged and failed to receive more aggressive therapy with regard to radiation field design or hormonal therapy. Brachytherapy boost was not widespread in the time period we examined, for example. It is unusual for radiation patients to undergo surgery after radiation.”
Overall survival was the only endpoint the investigators could analyze with this database, so they couldn’t attribute the findings to fewer deaths from prostate cancer. Since selection bias is possible with any retrospective review, future prospective research is warranted. The team is planning a trial investigating whether surgery patients reap benefit from the addition of radiation and systemic therapy.