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Prostatectomy Confers Greater Survival Benefit Than Radiotherapy in Nonmetastatic Cancer — Physician’s First Watch

Medical News |
February 28, 2014

Prostatectomy Confers Greater Survival Benefit Than Radiotherapy in Nonmetastatic Cancer

By Amy Orciari Herman

Among men with nonmetastatic prostate cancer, prostatectomy appears to reduce disease-specific mortality better than radiotherapy, an observational study in BMJ finds.

Using the Swedish national prostate cancer registry, researchers examined outcomes among nearly 35,000 men who underwent radical prostatectomy or radiotherapy as their primary treatment between 1996 and 2010. Median follow-up was 5 years.

Among men with nonmetastatic disease, prostate cancer mortality was significantly lower with surgery than with radiotherapy (1.4% vs. 4.9%). Men who were younger, had fewer comorbidities, and had higher-risk cancer appeared to benefit most from surgery.

Among men with metastatic cancer, on the other hand, disease-specific mortality did not differ according to treatment.

The authors, while acknowledging limitations to their research, conclude: "Our study suggests that surgery might result in improved outcomes compared with radiotherapy in terms of survival for men with non-metastatic prostate cancer."

Reader Comments (7)

Nancy Watts Other Healthcare Professional, Pathology

I appreciate the opportunity to read this later!

MD,DSc Physician, Other, Univ of Minnesota

Unfortunately, the comparison lacked balance and perspective. The dates for the inclusion included patients without a Gleason score and many whiteout a PSA. I suspect that Gleason score may have been done retrospectively, if at all. I had the opportunity to review data from that same period, and we elected to not include patents without Gleason scoring and there were many. One additional factor of significance, the data set does not include a Charlson comorbidity score, so this must have been done retrospectively which would add to the questions about the validity of the data.

Lennernäs, MD, PhD Physician, Oncology, Sahlgrenska Univ Hosp. Sweden

I have been working on the development of the RT PC in Sweden since 1990. This study was previously published in the EAU and has started the debate if we should close the main PC registry because its data is PUBLISHED with bad method. This study compares apples with pears because the RT PC during this time going from old pipe technologies to modern high dose. Before 1996, we had made 50 HDR brachytherapy, today it is the most common method in Sweden. Add to this the selection of patients and that the group has no clinical experience in RTPC in modern RT. Data does not get better if the group is large. Data should published, but the conclusions are incorrect and it is likely due to a lack of clinical competence to judge the development of the RT PC.

Bo Lennernas md, PhD Physician, Oncology

No, this is large, but not a well performed study. It has received serious comments in Sweden. The healthcare system disc if they should close the PC reg if they produce this kind of studies. It does not evaluate 2 comp. Groups. Maybe it highlights the need for better research in the area.

N CHARKES Physician, Internal Medicine, Temple Univ. Hospital

The groups were not comparable. There were more individuals with
higher Gleason scores and PSA values in the radiotherapy group,
among other differences. They should have compared identical
groups, but they didn't. Apples and pears. R.I.P.

edward filmer Retired Age 82

No cancer brachytherapy 2002- 2004 One TURP #2 Turp recommended NO GO due to Radiation& possible fistula. Therefore partial urination & #16 French catheter to fully eliminate #keep control.

Robert Lustig MD Physician, Oncology, University of Pennsylvania

The techniques and doses of radiation used for many patients in the study are not the current standard of care. This was not randomized and no conclusions regarding current recommendations for therapy can be concluded

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