Surgery vs. Radiation for Early Prostate Cancer

Men with prostate cancer that’s still confined to the organ are more likely to survive if they have surgery rather than radiation therapy, a new Canadian study suggests.

This type of “localized” prostate cancer is the most common form of the disease, accounting for about 80 percent of cases, said a team led by Dr. Robert Nam of the Odette Cancer Centre at Sunnybrook Research Institute in Toronto.
The most common treatments for localized prostate cancer are surgery and radiation therapy.

But which works best to keep the disease at bay?

To find out, Nam’s team looked over data from 19 studies that included a total of nearly 119,000 men with localized prostate cancer.

Findings from 15 of the studies showed that those who received radiation therapy were twice as likely to die from prostate cancer as those who had surgery.

Findings from 10 of the studies also showed that men who had radiation therapy were 50 percent more likely to die sooner of any cause, compared to those who had surgery.

The results of the analysis were published Dec. 14 in the journal European Urology.

“In the past, studies that have compared the success rates of surgery or radiation have been confusing because of their methods,” Nam said in a journal news release. “We have evaluated all the good-quality data comparing surgery and radiotherapy, and the results are pretty conclusive; in general, surgery results in better mortality rates than radiotherapy.”

But prostate cancer treatment is never a one-size-fits-all matter, he added.

“There are times when radiotherapy may be more appropriate than surgery, so it is important that a patient discusses treatment options with his clinician,” Nam said.

He believes that “the important thing about this research is that it gives physicians and patients additional information to consider when making the decision about how to treat localized prostate cancer.”

Two U.S. experts came to somewhat different conclusions about the results.

“The results of this study point not only to the efficacy of surgery as a principal mode of treatment and first line of defense against prostate cancer, but also as a way to extend the life of men affected by prostate cancer,” said Dr. David Samadi, chief of robotic surgery at Lenox Hill Hospital in New York City.

He said that surgical removal of the prostate “is the only option which removes the entire prostate, and therefore allows for more accurate staging and grading [of the tumor]. This means your doctor can create a better long-term plan of care for each individual patient.”

And Samadi stressed that “radiation is still possible as a secondary treatment after surgery. So patients have yet another way of combating their cancer if necessary.”

But another expert had some reservations about the study. Dr. Jonathan Haas is chief of radiation oncology at Winthrop-University Hospital in Mineola, N.Y. He said that the Canadian review may not have accounted for recent improvements in radiation treatment that could boost outcomes for patients.

According to Haas, what’s needed to answer the surgery-versus-radiation question is a “prospective randomized trial using state-of-the-art medicine.”

“Only then can the best conclusion be made,” he said. “Patients with this disease have many options including radiation, surgery, and possibly even surveillance. Only by individualizing a treatment plan for an individual patient with their specific information can the best outcomes be obtained.”

Sources : David Samadi, M.D., chairman, urology, and chief, robotic surgery, Lenox Hill Hospital, New York City; Jonathan Haas, M.D., chief of radiation oncology, Winthrop-University Hospital, Mineola, N.Y.; European Urology, news release, Dec. 14, 2015 (Health Day)

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