New study below [1].
This study was mentioned in a side issue that arose in the "Lymph Node Dissection [LND] & Salvage Radiotherapy [sRT]" thread.
Tall-Allen had objected to my claiming better survival for radical prostatectomy [RP].
14 years ago, the online tool I used, showed RP to give me a 10-year survival probability of not much less than if I were disease-free. Radiation on the other hand reduced that probability by about 5 points.
Since then in retrospective studies that I have seen, surgery has always beaten radiation.
Granted, not every study controlled for co-morbidity.
Allen argued that newer data would show that RP was no longer the gold standard. In support, he included a link to his analysis of the new study [2]:
"Brachy boost therapy and surgery extend survival about the same in high risk patients, but brachy boost does more"
The quotes below are from [1].
"To compare clinical outcomes of patients with Gleason score 9-10 prostate cancer after definitive treatment." (i.e. this is a minority of cases.)
"Adjusted 5-year prostate cancer-specific mortality rates were RP, 12% ..; EBRT, 13% ..; and EBRT+BT, 3% ..."
That last number is impressive.
"Adjusted 5-year incidence rates of distant metastasis were RP, 24% ..; EBRT, 24% ..; and EBRT+BT, 8% ..."
Again, impressive!
The Abstract doesn't show 10-year data, so the following is from [2]:
"The 10-year rates of prostate cancer-specific mortality (PCSM) were
23% for RP
26% for EBRT
13% for EBRT + BT"
"The 10-year rates of all-cause mortality (ACM) were
32% for RP
39% for EBRT
31% for BBT"
Overall mortality for RP & BBT were basically the same. (What we make on the swings, we lose on the roundabouts. P.G. Wodehouse)
Subtracting the numbers for other-cause mortality (non-PCa):
9% for RP
13% for EBRT
18% for BBT
So there appears to be a price to be paid. Seems hard to believe that the EBRT+BBT guys had more extensive comorbidities than the EBRT-only men. So, did treatment result in greater other-cause death? & is so, shouldn't the PCa-mortality numbers be adjusted to reflect that?
-Patrick
[1] ncbi.nlm.nih.gov/pubmed/295...
JAMA. 2018 Mar 6;319(9):896-905. doi: 10.1001/jama.2018.0587.
Radical Prostatectomy, External Beam Radiotherapy, or External Beam Radiotherapy With Brachytherapy Boost and Disease Progression and Mortality in Patients With Gleason Score 9-10 Prostate Cancer.
Kishan AU1, Cook RR2, Ciezki JP3, Ross AE4, Pomerantz MM5, Nguyen PL6, Shaikh T7, Tran PT8, Sandler KA1, Stock RG9, Merrick GS10, Demanes DJ1, Spratt DE11, Abu-Isa EI11, Wedde TB12, Lilleby W12, Krauss DJ13, Shaw GK5, Alam R4, Reddy CA3, Stephenson AJ14, Klein EA14, Song DY8, Tosoian JJ4, Hegde JV1, Yoo SM1, Fiano R10, D'Amico AV6, Nickols NG1,15, Aronson WJ16, Sadeghi A15, Greco S8, Deville C8, McNutt T8, DeWeese TL8, Reiter RE16, Said JW17, Steinberg ML1, Horwitz EM7, Kupelian PA1,18, King CR1.
Author information
Abstract
IMPORTANCE:
The optimal treatment for Gleason score 9-10 prostate cancer is unknown.
OBJECTIVE:
To compare clinical outcomes of patients with Gleason score 9-10 prostate cancer after definitive treatment.
DESIGN, SETTING, AND PARTICIPANTS:
Retrospective cohort study in 12 tertiary centers (11 in the United States, 1 in Norway), with 1809 patients treated between 2000 and 2013.
EXPOSURES:
Radical prostatectomy (RP), external beam radiotherapy (EBRT) with androgen deprivation therapy, or EBRT plus brachytherapy boost (EBRT+BT) with androgen deprivation therapy.
MAIN OUTCOMES AND MEASURES:
The primary outcome was prostate cancer-specific mortality; distant metastasis-free survival and overall survival were secondary outcomes.
RESULTS:
Of 1809 men, 639 underwent RP, 734 EBRT, and 436 EBRT+BT. Median ages were 61, 67.7, and 67.5 years; median follow-up was 4.2, 5.1, and 6.3 years, respectively. By 10 years, 91 RP, 186 EBRT, and 90 EBRT+BT patients had died. Adjusted 5-year prostate cancer-specific mortality rates were RP, 12% (95% CI, 8%-17%); EBRT, 13% (95% CI, 8%-19%); and EBRT+BT, 3% (95% CI, 1%-5%). EBRT+BT was associated with significantly lower prostate cancer-specific mortality than either RP or EBRT (cause-specific HRs of 0.38 [95% CI, 0.21-0.68] and 0.41 [95% CI, 0.24-0.71]). Adjusted 5-year incidence rates of distant metastasis were RP, 24% (95% CI, 19%-30%); EBRT, 24% (95% CI, 20%-28%); and EBRT+BT, 8% (95% CI, 5%-11%). EBRT+BT was associated with a significantly lower rate of distant metastasis (propensity-score-adjusted cause-specific HRs of 0.27 [95% CI, 0.17-0.43] for RP and 0.30 [95% CI, 0.19-0.47] for EBRT). Adjusted 7.5-year all-cause mortality rates were RP, 17% (95% CI, 11%-23%); EBRT, 18% (95% CI, 14%-24%); and EBRT+BT, 10% (95% CI, 7%-13%). Within the first 7.5 years of follow-up, EBRT+BT was associated with significantly lower all-cause mortality (cause-specific HRs of 0.66 [95% CI, 0.46-0.96] for RP and 0.61 [95% CI, 0.45-0.84] for EBRT). After the first 7.5 years, the corresponding HRs were 1.16 (95% CI, 0.70-1.92) and 0.87 (95% CI, 0.57-1.32). No significant differences in prostate cancer-specific mortality, distant metastasis, or all-cause mortality (≤7.5 and >7.5 years) were found between men treated with EBRT or RP (cause-specific HRs of 0.92 [95% CI, 0.67-1.26], 0.90 [95% CI, 0.70-1.14], 1.07 [95% CI, 0.80-1.44], and 1.34 [95% CI, 0.85-2.11]).
CONCLUSIONS AND RELEVANCE:
Among patients with Gleason score 9-10 prostate cancer, treatment with EBRT+BT with androgen deprivation therapy was associated with significantly better prostate cancer-specific mortality and longer time to distant metastasis compared with EBRT with androgen deprivation therapy or with RP.
PMID: 29509865 DOI: 10.1001/jama.2018.0587
[Indexed for MEDLINE]
...
My 80 year-old dad with MPCa, broke his leg and now seems to be giving up. Advice on best anti-anxiety meds desperately needed.
Advanced Prostate Cancer to bone and liver
Old Guy Update
Dad’s blood reports. PSA and testosterone down but ALP up 
Patient refuses abiraterone
