Surgery is superior to radiotherapy in men with localized prostate cancer

Surgery offers a better survival benefit for men with localized prostate cancer, according to a large observational study.

"The current gold standard management of localized prostate cancer is radical therapy, either as surgery or radiation therapy. This study suggests that surgery is likely superior to radiation for the majority of men who have localized prostate cancer, especially the younger age group and those with no or few comorbidities," said lead study author Prasanna Sooriakumaran, MD, PhD, of Karolinska University Hospital in Stockholm, Sweden.

In their study, Sooriakumaran and colleagues from Sweden and the Netherlands compared the oncologic effectiveness of radical prostatectomy and radiotherapy in prostate cancer, and analyzed the mortality outcomes in 34,515 patients treated with up to 15 years follow-up.

Data from Sweden's National Prostate Cancer Registry showed that the men were treated for prostate cancer throughout Sweden with either surgery (n=21,533) or radiotherapy (n=12,982) as their first treatment option and form the study cohort. Patients were categorized by risk group (localized low risk, localized intermediate risk, localized high risk, and nonlocalized, with the patients having any T3-4, N+, M+, PSA >50), age (younger than 65 years, 65 to 74 years, or 75 years and older), and Charlson comorbidity index (0, 1, ≥2).

In their results, the researchers said radiotherapy patients generally had higher Gleason sums and clinical stages, were older, and had higher PSA levels than patients that underwent surgery (P <.0001 for all comparisons). Prostate cancer mortality became a larger proportion of overall mortality as risk group increased for both the surgery and radiotherapy cohorts. The study also showed that survival outcomes favored surgery for patients with localized prostate cancer (risk groups 1 to 3), and that treatment results were similar for locally advanced/metastatic patients.

"This study may herald an increasing use of surgery over radiation in this group. Also, our study concluded that for men with advanced prostate cancer, both modalities appear equivalent and thus the conventional view that surgery is not indicated in this group may be incorrect," explained Sooriakumaran. He added that with his group's results, a majority of men with low-risk prostate cancer do not die of the disease.

"A very long follow-up period is needed to make any comments regarding comparative oncologic outcomes between treatments. Hence, the use of active surveillance may be appropriate in men with low-risk disease," Sooriakumaran pointed out.

However, men with intermediate- and high-risk disease have a relatively high probability of dying from prostate cancer. "Especially when we look at the absolute numbers involved," he said, adding that radical treatment, preferably in the form of surgery, is warranted if possible.

This study was presented at the 28th European Association of Urology Congress, which was held in Milan, Italy, March 15-19, 2013.

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