Men Diagnosed with Advanced Prostate Cancer Have a Longer Survival if They Have Surgery Followed by Radiation

One of the on-going debates surrounds the question, should men with newly diagnosed advanced prostate cancer have a radical prostatectomy (RP).  In a retrospective study, it was found that men lived longer if they had an RP followed by adjuvant radiotherapy (XRT). The study was reported in, Cancer, a very reputable Journal.

According to Dr. Thomas L. Jang of the Rutgers Cancer Institute of New Jersey in New Brunswick and colleagues, the study also showed that they also had more side effects than men treated with primary XRT followed by androgen deprivation therapy (ADT).

"With either multimodal approach these patients with high-risk prostate cancer can achieve a very durable and sustained disease-free interval and control of their cancer," Dr. Jang told Reuters Health by phone. "That said, we did find that the patients who received surgery followed by radiation did appear to have better survival."

Current guidelines do recommend that men with newly diagnosed advanced prostate cancer be given multimodal treatment, but the guidelines don't specify which type of treatment.

The study was a population-based comparative effectiveness study using Surveillance, Epidemiology, and End Results (SEER) - Medicare data on 13,856 men 65 and older diagnosed with locally or regionally advanced prostate cancer in 1992-2009. Overall, 6.1% received RP plus XRT and 23.6% XRT plus ADT.

During follow-up, which lasted a median 14.6 years, 2,189 of the men died, and 702 deaths were secondary to prostate cancer. Both with and without propensity score adjustment, patients who received RP plus XRT had better overall and prostate cancer-specific survival than those who had ADT plus XRT, independently of tumor stage, nodal involvement or Gleason score. 

The adjusted overall 10-year survival ranged from 72% to 88.9% with RP plus XRT, and 58.6% to 74.2% with XRT plus ADT.

As far as the side effects experienced men in the RP plus XRT group, 49.1% were diagnosed with urinary incontinence, versus 19.4% of the XRT plus ADT group. Erectile dysfunction (ED) was diagnosed in 28.3% of the RP plus XRT group compared to 20.4% of the XRT plus ADT group. The men who underwent surgery were also more likely to undergo procedures to treat urinary incontinence or ED.

Despite the unambiguous guidelines Dr. Jang noted that half of the men did not receive multimodal treatment, while 20% received no treatment at all. 

 Cancer 2018

Joel T Nowak, MA, MSW