Surgery provides excellent long-term cancer control and high survival rates for men with aggressive prostate cancer, a new study suggests.
In the study by researchers from the Mayo Clinic, Rochester, Minnesota, and Fox Chase Cancer Center, Philadelphia, men with high-risk prostate cancer who underwent radical prostatectomy had a 10-year cancer-specific survival rate of 92% and an overall survival rate of 77%.
Men who had radiation plus hormone therapy also had a 92% cancer-specific survival rate, but their overall survival rate was significantly lower at 67%. For men treated with radiation alone, the overall survival rate was just 52%.
The findings were presented at the 84th Annual Meeting of the North Central Section of the American Urological Association in Chicago.
"It's long been believed that patients with aggressive prostate cancer are not candidates for surgery," said Stephen Boorjian, MD, a Mayo Clinic urologist in a press release. "We found that surgery does provide excellent long-term cancer control for this type of prostate cancer. In addition, by allowing the targeted use of secondary therapies such as androgen deprivation, surgery offers the opportunity to avoid or at least delay the potentially adverse health consequences of these treatments."
Of the 1847 patients with aggressive prostate cancer (as defined by the National Comprehensive Cancer Network) included in the study, 1238 underwent radical prostatectomy and 609 were treated with radiation therapy. Of the 609 receiving radiation therapy, 344 also received androgen deprivation therapy.
"Patients with radiation and hormone therapy were 50% more likely to die than patients who had surgery," Boorjian said. "This was true even after controlling for patient age, comorbidities and features of the tumors. These results suggest that use of hormone therapy in patients who received radiation therapy may have had adverse health consequences.”
He added that “limiting the need for hormones may avoid adverse health consequences.” But he said that further studies evaluating the differing impacts of treatments on quality of life and non-cancer mortality will be needed to determine the best approach for men with high-risk prostate cancer.