Prostate cancer survival is better with surgery than with radiotherapy

Men with localized prostate cancer who were treated with radical prostatectomy surgery had better survival rates than those treated with radiotherapy, according to a meta-analysis that included nearly 120,000 patients. This result remained even after accounting for the type of radiation and the aggressiveness of cancer, researchers concluded in their study published online December 15, 2015 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. 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,” said senior author Robert Nam, MD, MSc, Head of Genitourinary Oncology and Professor of Surgery at Odette Cancer Centre at Sunnybrook Research Institute, University of Toronto, in Toronto, Canada.

In this meta-analysis, Dr. Nam and colleagues reviewed 19 studies that included a total of 118,830 patients with localized prostate cancer who had undergone treatment with either surgery or radiation. Fifteen of the studies reported on prostate cancer-specific mortality, and showed that patients were twice as likely to die from prostate cancer after being treated with radiation compared with surgery.

Ten of the studies also looked at overall mortality and found that patients treated with radiation were about one and half times more likely to die sooner than patients who had surgery.

“Both treatment approaches should be discussed with patients prior to the start of therapy,” Dr. Nam said. “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.”

“We certainly need to take this analysis into account, but it doesn’t yet give us a definitive answer as to the best treatment,” said Nicolas Mottet, MD, PhD, Chairman of the European Association of Urology Prostate Guideline Panel, commenting on the study. “Although this paper should not change clinical practice, I agree with the authors: this analysis gives us important additional information.”

Dr. Mottet added that a definitive answer is coming in the form of a large randomized controlled clinical trial—the PROTECT study—due next year.