Radical Prostatectomy [RP] versus Radiotherapy.

[pjoshea13]

New study below. (Somewhat off-topic, but newly-diagnosed men sometimes seek advice from old-timers.)

I find it interesting that the subject has not yet been laid to rest, but there are vocal oncologists who deny that RP gives better survival results.

"We analyzed 268,378 men with intermediate-risk prostate cancer from 2004 to 2012."

"Studies of various prostate cancer patient cohorts found men receiving external-beam radiotherapy (EBRT) had higher mortality than men undergoing radical prostatectomy (RP). Conversely, a recent clinical trial showed no survival differences between treatment groups. We used the National Cancer Data Base (NCDB) to evaluate overall survival in intermediate-risk (T2b-T2c or Gleason 7 [grade group II or III] or prostate-specific antigen 10-20 ng/mL) prostate cancer patients undergoing EBRT with or without androgen deprivation therapy (ADT), RP, or no initial treatment."

"Men undergoing RP had significantly lower adjusted mortality risk than men receiving either EBRT ... or EBRT + ADT" 59% less risk in both cases. "No difference was observed between men receiving EBRT or EBRT + ADT"

"Men treated with RP experienced significantly lower overall mortality risk than EBRT with or without ADT and no-treatment patients ..."

-Patrick

ncbi.nlm.nih.gov/pubmed/288...

Clin Genitourin Cancer. 2017 Aug 9. pii: S1558-7673(17)30239-2. doi: 10.1016/j.clgc.2017.07.029. [Epub ahead of print]

Survival Outcomes of Radical Prostatectomy Versus Radiotherapy in Intermediate-Risk Prostate Cancer: A NCDB Study.

Marsh S1, Walters RW2, Silberstein PT2.

Author information

1

Creighton University School of Medicine, Omaha, NE. Electronic address: [e-mail].

2

Creighton University School of Medicine, Omaha, NE.

Abstract

BACKGROUND:

Studies of various prostate cancer patient cohorts found men receiving external-beam radiotherapy (EBRT) had higher mortality than men undergoing radical prostatectomy (RP). Conversely, a recent clinical trial showed no survival differences between treatment groups. We used the National Cancer Data Base (NCDB) to evaluate overall survival in intermediate-risk (T2b-T2c or Gleason 7 [grade group II or III] or prostate-specific antigen 10-20 ng/mL) prostate cancer patients undergoing EBRT with or without androgen deprivation therapy (ADT), RP, or no initial treatment.

PATIENTS AND METHODS:

We analyzed 268,378 men with intermediate-risk prostate cancer from 2004 to 2012. Kaplan-Meier estimates and multivariable Cox proportional hazards models were used to compare survival between treatments.

RESULTS:

After adjusting for patient and facility covariables, men receiving no initial treatment averaged greater adjusted mortality risk than men receiving EBRT (hazard ratio [HR], 1.71; 95% confidence interval [CI] 1.62-1.80; P < .001), EBRT + ADT (HR, 1.73; 95% CI 1.64-1.81; P < .001), or RP (HR, 4.18; 95% CI 3.94-4.43; P < .001). Men undergoing RP had significantly lower adjusted mortality risk than men receiving either EBRT (HR, 0.41; 95% CI 0.39-0.43; P < .001) or EBRT + ADT (HR, 0.41; 95% CI 0.39-0.43; P < .001). No difference was observed between men receiving EBRT or EBRT + ADT (HR, 1.01; 95% CI 0.97-1.05; P = .624).

CONCLUSION:

Men treated with RP experienced significantly lower overall mortality risk than EBRT with or without ADT and no treatment patients, regardless of patient, demographic, or facility characteristics. The results are limited by the lack of cancer-specific mortality in this database.

Copyright © 2017 Elsevier Inc. All rights reserved.

KEYWORDS:

Cancer treatment; Genitourinary malignancy; National Cancer Data Base; Overall survival; Retrospective study

PMID: 28869138 DOI: 10.1016/j.clgc.2017.07.029

[Dr_WHO]

Thank you for the article. It would indeed be useful to men just diagnosed.

I would go a step forward and say that surgery is a viable option even if the cancer has spread past the prostate. While it is true that the cancer cells have spread throughout the body, there is benefit to removing the primary source of cancer. The pathology report is also a lot more reliable than a biopsy. That is how they found that my cancer was ductal. Recently they recognized that men with Stage 4D1 (migration to the pelvic area) live longer with surgery. A review is listed below.

urology.jhu.edu/newsletter/...

Early last year I had to argue with my surgeon to even have surgery as it had spread to my pelvic lymph nodes. Luckily I won that argument. I have to wonder if men with "mild" Stage 4D2 (spread to distant organs or bones) would also benefit.

[pjoshea13 in reply to Dr_WHO]

I agree. The intact prostate will continue to spew out PCa cells. It's as though doctors view mets as a "game over" situation & see no reason to cut off the supply of circulating PCa cells.

I can see that a systemic approach is needed, but the factory should be shut down IMO.

-Patrick

[Dayatatime]

When hearing about doctors not willing to offer localized treatment to patients with disease outside of prostate it truly makes me frustrated. What if the cancer only went to the nodes and a guy got lucky enough where they managed to stop it in its tracks when removing them?? What if what they are seeing in scans is actually scar tissue from ADT and chemo or just large nodes?? What if by taking the prostate out they managed to take care of billions of castrate resistant cells and give a guy possibly 10 or more years to live?

By not taking action it is a guaranteed outcome with aggressive disease. If a patient has a doctor that is still thinking under the assumption of "once outside of the barn door its to late" find a new doctor. I had 5 different doctors tell me exactly that and finally went to a major league hospital and surgery was offered. I'm 9 months out and current PSA at <0.01 with no signs of disease and it was Gleason 9, PSA 286 at diagnosis with node involvement in pelvis and abdomen. Had I not had surgery and only listened to my local docs there is no way that could've happened.

Learn about your disease, stay current, be persistent and get different opinions from major hospitals. You are your own best health care and it will be you that needs to make things happen.

Ron

[AlanMeyer in reply to Dayatatime]

Ron,

If you had no hormone therapy, your results are astoundingly good. Did you have any hormone (or other systemic) therapy?

Thanks.

Alan

[Dayatatime in reply to AlanMeyer]

Yes that is with hormone therapy. I am currently on a 6 month injection of Lupron and 50 mg of Bicalutamide for 2 years postoperative treatment. If any cancer left floating around hopefully that will help take care of it. The true test will be when I come off from that in another year and 3 months if numbers hold at undetectable.

I was diagnosed February 2016 and along with the above mentioned ADT starting from the beginning I also did 6 rounds of docetaxel starting in June of same year. The doctors used the words "bulky" disease in my nodes when diagnosed. When nodes were taken out during surgery it was discovered that it was scar tissue actually showing in scans thought to be cancer. Out of 42 nodes only 1 tested positive. I responded very well to ADT and chemo, the chemo did some major damage to the existing cancer before surgery and the ADT kept it at bay. Preoperative PSA was .51 postoperative <0.01

I recovered very well from the surgery and remain cautiously optimistic. Even if I should have a recurrence the procedure added years to my life. At 48 years old I would be more than happy to take another 30.

Ron

[Dayatatime in reply to Dayatatime]

Forgot to mention I also had the surgery in December of 2016 at Mayo Clinic in MN. Needless to say 2016 was a hell of a ride.

[AlanMeyer in reply to Dayatatime]

I bet it was a hell of a ride.

However, it sounds like you got the most aggressive possible treatment at one of the best places in the world to get it, and your response to the treatment so far has been great.

I'm hopeful that you're through the worst of it and you'll have many, many healthy years to come.

Best of luck.

Alan

[Sisira]

I can easily agree with the above conclusion even with a general knowledge on PCa because especially in the case of high risk PCa, wherever possible RP means removal of the main generator of the cancer with the highest concentration of all different types of PCa cells. Debulking on the other hand will result in a much lower cancer burden to deal with in the decease management. The systematic and scientific study throwing more light on the subject and also drawing a comparison with EBRT definitely is very informative.

Thank you Patrick for your post.

Sisira

[Hidden]

I'm not surprised that HIFU wasn't mentioned in the study. I was told by two urologists that I wasn't a good candidate for RP after having had TURP surgery 10 years prior to PC dx. I opted for HIFU rather than radiation. My non-medical brain came to the conclusion that HIFU was a precision instrument and that radiation was a blunt instrument. HIFU provides real time feedback on not only where the energy is being focused, but on what temperature the tissue is reaching. Other than the calypso markers to provide some directional calibration I don't see where radiation can be that precisely targeted. I am an engineer. In my world precise feedback is the key to a system functioning as desired. Quality of life risks were also important in my decision.