Two studies, one from Memorial Sloan-Kettering Cancer Center and the other from the CaPSURE database suggested that after adjustment for comorbidities radical prostatectomy (RP) had better long-term survival compared to radiotherapy (XRT). In the online issue of Cancer, Dr. Stephen Boorjian and colleagues from the Mayo Clinic and Fox Chase Cancer Center report from their two institution series that the 10-year CaP control is comparable, but overall survival is superior with surgery.
Between 1988 and 2004 a total of 1,847 patients were identified with high-risk CaP who underwent RP at the Mayo Clinic (n=1,238) or XRT at Fox Chase (n=609). All surgical patients underwent open RP, and 503 men (40.6%) received adjuvant therapy (367 had androgen deprivation therapy, 85 XRT, and 51 both). Salvage therapy was given to 253 men (20.4% had RT, 415 men had ADT). The median time interval from RP to salvage therapy was 2.7 years for XRT and 20.3 years for ADT. Over the time period of the study, XRT methodology evolved from conventional to 3-D conformal to intensity-modulated. The median dose delivered was 72 Gy, and 344 men (56.5%) also received adjuvant ADT for a median duration of 22.8 months. Fifty-seven patients subsequently received salvage ADT at a median of 3.0 years after initial treatment. Survival was estimated by Kaplan-Meier methodology and outcomes controlled for baseline clinicopathologic and comorbidity differences.
Patients treated with XRT were older and had higher baseline PSA levels and Gleason scores. At 10.2 years after RP, 192 men experienced systemic progression (SP); 404 died, including 115 from CaP. A total of 27 men who received XRT plus ADT and 35 who received XRT alone experienced SP with 90 and 118 deaths, respectively - including 19 and 25 from CaP, respectively. The estimated 10-year probability of freedom from SP did not differ between RP (85%), XRT/ADT (88%), and XRT alone (81%). The 10-year CaP-specific survival was 92% for RP and XRT/ADT and 88% for XRT alone. Patients who had surgery had significantly better 10-year overall survival at 77%, compared to 67% for XRT/SDT and 52% for XRT alone. After controlling for age, year of treatment, pretreatment PSA, clinical stage, and biopsy Gleason score, patients who had XRT alone had a significantly higher risk of SP (HR=1.53), death from CaP (HR=2.14), and overall death (HR=2.04) compared with men who had RP or XRT/ADT. XRT plus ADT demonstrated a significantly increased risk of all-cause mortality compared with surgery (HR=1.6).
Boorjian SA, Karnes RJ, Viterbo R, Rangel LJ, Bergstralh EJ, Horwitz EM, Blute ML, Buyyounouski MK
Cancer. 2011 Jan 10. Epub ahead of print.
10.1002/cncr.25900
PubMed Abstract
PMID: 21225881
UroToday.com Prostate Cancer Section
