Yet another surgery v. radiation study.

[pjoshea13]

New paper below.

Although men with advanced PCa are well-beyond this issue, studies such as this counter the belief in some quarters that one should never choose surgery. "Invasion of the Prostate Snatchers" (by Mark Scholz and Ralph H. Blum) is often mentioned. Urologists know nothing about cancer, etc, etc.

In the new study the men were younger than 60, so presumably most could have opted for surgery. In much older men, surgery is often not a safe option & this can affect comparisons.

"We retrospectively analyzed the records of men younger than 60 years in the SEER (Surveillance, Epidemiology and End Results) database who underwent initial surgery or radiation therapy of high grade (Gleason score 8 or greater) localized (N0M0 TNM stage) prostate cancer from 2004 to 2012."

"A total of 2,228 men were identified, of whom 1,459 (65.5%) underwent initial surgery and had a median followup of 43 months and 769 (34.5%) underwent initial external beam radiation therapy with or without brachytherapy and had a median followup of 44 months."

"... initial treatment with surgery was associated with improved prostate cancer specific and overall mortality compared with initial radiation treatment (HR 0.37 ... vs HR 0.41 ...) when controlling for age, biopsy Gleason score, T stage and prostate specific antigen."

-Patrick

ncbi.nlm.nih.gov/pubmed/305...

J Urol. 2019 Jan;201(1):120-128. doi: 10.1016/j.juro.2018.07.049.

Evaluation of Cancer Specific Mortality with Surgery versus Radiation as Primary Therapy for Localized High Grade Prostate Cancer in Men Younger Than 60 Years.

Huang H1, Muscatelli S1, Naslund M1, Badiyan SN2, Kaiser A2, Siddiqui MM1.

Author information

1

Division of Urology, Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland.

2

Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland.

Abstract

PURPOSE:

The optimal primary treatment of localized high grade prostate cancer in younger men remains controversial. The objective of this project was to compare the impact of initial radical prostatectomy vs radiation therapy on survival outcomes in young men less than 60 years old with high grade prostate cancer.

MATERIALS AND METHODS:

We retrospectively analyzed the records of men younger than 60 years in the SEER (Surveillance, Epidemiology and End Results) database who underwent initial surgery or radiation therapy of high grade (Gleason score 8 or greater) localized (N0M0 TNM stage) prostate cancer from 2004 to 2012. Univariate and multivariate Cox proportional hazards regression models were used to examine prostate cancer specific and overall mortality.

RESULTS:

A total of 2,228 men were identified, of whom 1,459 (65.5%) underwent initial surgery and had a median followup of 43 months and 769 (34.5%) underwent initial external beam radiation therapy with or without brachytherapy and had a median followup of 44 months. On multivariate analysis initial treatment with surgery was associated with improved prostate cancer specific and overall mortality compared with initial radiation treatment (HR 0.37, 95% CI 0.19-0.74, p = 0.005 vs HR 0.41, 95% CI 0.24-0.70, p = 0.001) when controlling for age, biopsy Gleason score, T stage and prostate specific antigen.

CONCLUSIONS:

Our data showed significant survival differences in young men treated initially with surgery vs external beam radiation therapy of high grade prostate cancer. Future prospective randomized trials are needed to confirm the long-term outcomes of these treatment approaches.

PMID: 30577404 DOI: 10.1016/j.juro.2018.07.049

[NPfisherman]

Thank you, Patrick...Appreciate your posts.... Happy holidays...

[Schwah]

I like a lot of others here I’m sure have a little trouble understanding the terminology that spells out the different survival benefits of each methodology. Can you please state in simple terms of percentages for each method or better yet teach us all how to understand the “HR 0.37, 95%” etc etc. thank you.

Schwah

[pjoshea13 in reply to Schwah]

Schwah,

Hazard Ratio, Relative Risk & Odds Ratio.

HR (Hazard Ratio). Similar to RR (Relative Risk)

RR (Relative Risk) is the risk found in one group relative to another. So RR=0.79 for extreme quintiles of lycopene intake means 21% less risk for those in the top quintile compared to the bottom. RR=1.21 for smokers, say, would be 21% increased risk for smokers.

OR (Odds Ratio) is the probability of an event occurring divided by the probability of the event not occurring. Numerator + denominator = 1. e.g. 0.75/0.25 = 3.

Statistical Significance - p (probability) value. Basically, a measure of the probability of the finding being due to chance. So a p value of 0.05 corresponds to a confidence level of 95%. The smaller the p value, the better.

-Patrick

[Schwah in reply to pjoshea13]

Thanks Patrick. That’s very helpful to me and hopefully others.

Schwah

[Break60]

Thanks Patrick. This is no surprise to me except that I thought it had been found elsewhere that IMRT plus brachy boost was the best.

I sensed that the negative bias against RP were the side effects not the efficacy.

[wierdwood]

Keep in mind that this is a retrospective study and therefore should not be used to change SOC. That being said, this study generates more questions than answers. Examples:

1) How many patients died during this study? I would not have expected any of these men to die in the 3-4 year median follow up period unless they had metastatic disease. I would like to know more about how long these men were followed.

2) I would expect all failed surgery patients to have salvage radiation and possibly ADT. Most of the radiation patients that failed would have gone to ADT. This says to me that multi-modality is probability superior to single modality for high risk patients.

3) When radiation men had recurrence, what % recurred in gland? This can be improved with HDR.

I have looked at a lot of RCT's for men in this category and locally advanced. It was clear to me that HDR + IMRT+ADT gave the best outcomes.

Fred

[abmicro]

I think surgery is a better for high grade prostate cancer. Everything I read is that surgery has a slightly higher chance of success. If surgery fails, you can still do radiation later if you think you know where the cancer is. If you already did radiation, you already limited yourself to how much radiation you can do later to clean up tumors that pop up because you already did a huge dose of radiation on a curative attempt.

Radiation has side effects that linger for years, including lower blood counts, bone destruction, and nausea, so anytime you can cut the cancer out, or destroy the metastatic tumors with a non-radiation method, it is better according to my oncologist. Radiation is good for follow-up of tumors and spots that cannot be reached by other methods.

[j-o-h-n]

Yep the results are like kissing your sister (or brother).

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 12/26/2018 7:00 PM EST

[Hidden]

Well I guess I’m screwed . If your stats are right.