MDNews - Greater Boston

Study Questions Standard Treatment for Prostate Cancer A NEW STUDY SUGGESTS SURGERY MAY BE A SUPERIOR OPTION TO RADIOTHERAPY IN TREATING PATIENTS WITH LOCALIZED PROSTATE CANCER. IN study titled "Comparative Oncologic Effectiveness of Radical Prostatectomy and Radiotherapy in Prostate Cancer," researchers in Sweden and the Netherlands analyzed the outcomes of 34,515 cases in which men were treated with up to 15 years of follow-up care for prostate cancer. The analysis found the mortality rate of patients with localized prostate cancer was lower among those treated with surgery. A L ARG E OBSE RVATIONAL Surprising Results The research team used data from Sweden's National Prostate Cancer Registry to analyze 21,533 prostate cancer patients treated with surgery and 12,982 treated with radiotherapy. Cases were further broken down into categories according to localization, level of metastatic risk and scoring on the Charlson comorbidity index. In general, patients treated with radiotherapy had higher Gleason scores and fell into later clinical stages. Radiotherapy patients were also older and had higher prostate-specific antigen (PSA) levels than those who underwent surgical treatment. Findings revealed that patients treated surgically for localized prostate cancer experienced better survival rates as a group than those treated with radiotherapy. This held true especially for patients who were younger and had fewer comorbidities. A c c ord i n g t o le a d a ut h or P r a s a n n a Sooriakumaran, MD, PhD, the study's results were unexpected. 12 | Greater Boston MD NEWS I MDNEWS.COM "Standard treatment [for localized prostate cancer] is either surgery or radiation therapy, but radiation is actually more commonly used," Dr. Sooriakumaran says. "This study shows a benefit for surgery and thus challenges the current practice." Reconsidering Radiotherapy Potential differences in diagnostic and treatment practices between countries make it unclear what implications or applications this Europe-based study may have in the United States. The study seems to challenge current conclusions in the United States regarding treatment outcomes, as the American Cancer Society states that cure rates for men with localized prostate cancer treated with radiation therapy are "about the same" as those for men who receive radical prostatectomy. However, U.S. organizations aren't blind to the potential hazards of radiation therapy. The National Cancer Institute lists bladder cancer, rectal cancer, impotence and urinary problems as possible complications of radiation therapy for prostate cancer. Dr. Sooriakumaran hopes his study will urge clinicians to reconsider radiotherapy treatment for certain patients. "We would hope [this study] heralds the greater use of surgery in the management of men with prostate cancer," Dr. Sooriakumaran says. The study was presented in March 2013 at the 28th Annual EAU Congress in Milan, where it won second prize for Best Abstract in Oncology. I

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