Comparison of Multimodal Approaches in High-Risk Prostate Cancer

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Men treated with radical prostatectomy plus radiotherapy for locally or regionally advanced prostate cancer had improved survival but worse adverse events.
Men treated with radical prostatectomy plus radiotherapy for locally or regionally advanced prostate cancer had improved survival but worse adverse events.

A retrospective, observational study showed that men with high-risk prostate cancer treated with radical prostatectomy (RP) plus radiotherapy (XRT) had improved survival but worse adverse events than those who were treated with XRT plus androgen deprivation therapy (ADT).1 The study results were published online September 25, 2018, in Cancer.

To conduct the study, researchers evaluated Medicare claims data for patients diagnosed with locally advanced prostate cancer (LAPCa) or regionally advanced prostate cancer (RAPCa) between 1992 and 2009. After applying exclusion criteria, a total of 13,856 men were selected for the study and included in the analysis. Of these men, 6.1% underwent RP plus XRT and 23.6% underwent XRT plus ADT.

Independent of tumor stage or Gleason score, men who underwent RP plus XRT had higher adjusted 10-year prostate cancer–specific survival and 10-year overall survival than men who underwent XRT plus ADT.

However, men who underwent RP plus XRT had higher rates of urinary incontinence (49.1% vs 19.4%; P < .0001) and erectile dysfunction (28.3% vs 20.4%; P = .0212) than those who were treated with XRT plus ADT. These men also had higher rates of procedures to treat urinary incontinence (12.4% vs 1.6%; P = .0007) or erectile dysfunction (8.4% vs 3.7%; P = .0186).

“In summary, although our results are limited by the usual biases of an observational study design, men with LAPCa or RAPCa who received primary RP with post-surgery XRT had a lower risk of death from prostate cancer and had improved overall survival in comparison with those treated with primary XRT plus ADT,” the study authors wrote.

“These findings should be verified with prospective trial data and suggest the need to include a surgical arm in future trials for men with high-risk prostate cancer.”

Reference

  1. Jang TL, Patel N, Faiena I, et al. Comparative effectiveness of radical prostatectomy with adjuvant radiotherapy versus radiotherapy plus androgen deprivation therapy for men with advanced prostate cancer [published online September 25, 2018]. Cancer. doi: 10.1002/cncr.31726

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