Surgery superior over radiation in reducing mortality

A recent meta-analysis published in the July 2016 European Association of Urology journal found consistently higher mortality rates for patients diagnosed with localized prostate cancer who were treated with radiation rather than surgery.  This review is the most comprehensive and up-to-date study on this topic and may aid in clinical decision making by a physician.

Localized prostate cancer in men is when cancer is found only in the prostate gland and has not spread or metastasized to another part of the body.  Under this circumstance, a man will usually have an option of either to treat the cancer with radiation or surgery.

There had never been any published randomized controlled trials comparing the effectiveness or success between radical prostatectomy surgery and radiotherapy or radiation of this magnitude in men with nonmetastatic prostate cancer.  In radical prostatectomy, the surgery removes the prostate gland along with some of the tissue around it.  This type of surgery can be done open or by laparoscopic surgery through small incisions.  Radiotherapy is used to shrink the tumor and to kill off most of the cancer cells in the area.

For this review, nineteen randomized controlled trials, cohort, and case-control studies were used of low to moderate risk of bias with over 118,000 men of any age with nonmetastatic prostate cancer. What the researchers identified was an increased overall and prostate cancer-specific mortality for men treated with radiotherapy compared with those treated with surgery for clinically localized prostate cancer.

A comparable meta-analysis conducted in 2014 had similar findings when they examined the survival outcomes among patients with only high risk prostate cancer treated with surgery or radiotherapy – they came to the same conclusion that the patients treated with surgery compared with patients treated with radiotherapy, had better overall survival rates.

Generally, men with localized prostate cancer treated with radiotherapy tend to be older and have a higher level of comorbidities or the presence of two chronic diseases or conditions at the same time which could explain some of the higher mortality rates of men treated only with radiation. 

Also, men initially treated with surgery may undergo radiation while men whose cancer returns after radiation are typically then managed with androgen deprivation therapy (ADT) with the goal being to reduce levels of male hormones called androgens in the body to stop them from affecting prostate cancer cells stimulating them to grow. 

Any man diagnosed with prostate cancer should have a thorough discussion with his doctor to explore both treatment options.

Patients newly diagnosed with prostate cancer can contact world renowned prostate cancer surgeon and urologic oncologist, Dr. David Samadi, for a free consultation by calling 212-365-5000.