Radical prostatectomy (RP) offers better survival odds than radiation therapy among patients with high-risk prostate cancer (PCa) and low PSA levels, a new study suggests.

Using data from the Surveillance, Epidemiology and End Results (SEER) database, investigators identified 9114 men with Gleason 8 to 10 PCa and PSA levels of 10 ng/mL or less. To date, no uniform treatment standard exists for this group of patients, they noted.

Of the 9114 patients, 4175 underwent RP, 4114 received external beam radiation therapy (EBRT), and 825 received EBRT plus brachytherapy (EBRT + BT). The study population had a median follow-up duration of 47 months.

Compared with RP, EBRT and EBRT+BT were significantly associated with an approximately 3.4-fold and 2.1-fold increased risk of death from any cause, respectively, in adjusted analyses, Yadong Guo, MD, and colleagues at Tongji University in Shanghai, China, reported in Frontiers in Oncology. EBRT was significantly associated with a nearly 2.5-fold increased risk of PCa-specific mortality compared with RP. The risk of PCa-specific mortality did not differ significantly between RP and EBRT+BT. In addition, RP and EBRT+BT were associated with similar survival among men older than 70 years or those who had PSA levels of 2.5 ng/mL or less. The investigators concluded that EBRT+BT could be an alternative option for these patients.

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In addition to the retrospective nature of the study, limitations include the absence of data in the SEER database on treatment details such as use of androgen deprivation therapy, radiation dosage, and comorbidities.


Guo Y, Mao S, Zhang A, et al. Survival significance of patients with low prostate-specific antigen and high-grade prostate cancer after radical prostatectomy, external beam radiotherapy, or external beam radiotherapy with brachytherapy. Front Oncol. 2019. doi: 10.3389/fonc.2019.0068

This article originally appeared on Renal and Urology News