Radical Prostatectomy or Radiotherapy for High and Very High Risk Prostate Cancer?

[pjoshea13]

New study from MD Anderson.

"Long-term outcomes appear similar among high and very high-risk prostate cancer patients deemed eligible for either RP or RT and treated after consultation in a multidisciplinary prostate cancer clinic."

So, to those who are beating themselves up over making the wrong choice - stop it.

Of course, some will say that radiation is so much better today than it was in 2004-2013.

-Patrick

ncbi.nlm.nih.gov/pubmed/310...

BJU Int. 2019 Apr 22. doi: 10.1111/bju.14780. [Epub ahead of print]

Radical Prostatectomy or Radiotherapy for High and Very High Risk Prostate Cancer: A Multidisciplinary Clinic Experience of Patients Eligible for Either Treatment.

Reichard CA1, Hoffman KE2, Tang C2, Williams SB3, Allen PK2, Achim MF1, Kuban DA2, Chapin BF1.

Author information

1

Departments of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX.

2

Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.

3

Department of Surgery, Division of Urology, The University of Texas Medical Branch, Galveston, TX.

Abstract

OBJECTIVE:

To compare RP vs. RT with ADT in the setting of high and very high risk patients that were deemed eligible for either therapy and made a treatment choice after consultation in a multidisciplinary prostate cancer clinic (multi-clinic), and to compare the multi-clinic patient outcomes to a matched SEER cohort.

SUBJECTS AND METHODS:

Prospectively collected, retrospective study comparing RP (n=231) versus RT+ADT (n=73) from 2004-2013. Biochemical recurrence (BCR), Local recurrence, Distant metastasis failure, and overall survival (OS) were calculated for each treatment group overall and according to NCCN risk strata. A propensity score matched comparison with a SEER cohort was performed for overall survival.

RESULTS:

There was no difference in local recurrence (HR 2.7; 95%CI 1.0-7.9, p=0.06), distant metastasis failure (HR 2.5; 95%CI 0.8-7.8, p=0.1) and overall survival (HR 1.35; 0.4-4.8, p=0.6) between patients undergoing RP versus RT+ADT. Patients treated via the multi-disciplinary clinic survived on average 16.9 months (95%CI 13.1-20.8) longer than those in the SEER matched cohort.

CONCLUSIONS:

Long-term outcomes appear similar among high and very high-risk prostate cancer patients deemed eligible for either RP or RT and treated after consultation in a multidisciplinary prostate cancer clinic. Outcomes of the multi-clinic patients were superior to those of the matched SEER cohort. This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.

KEYWORDS:

high risk; multidisciplinary; radical prostatectomy; radiotherapy; robotic

PMID: 31009137 DOI: 10.1111/bju.14780

[bdriggers]

Are you one of the “ some” who believe RT

Has improved over 5 or 6 years?

[Hidden in reply to bdriggers]

I’m one that did RT and adt over 3 years ago ,so far with great success.

[pjoshea13 in reply to bdriggers]

Surgery or radiation? Unfortunately, it's a partisan issue at the provider level & it becomes so at the patient level. As for newer treatments, I'll wait for the long-term studies.

-Patrick

[bdriggers in reply to pjoshea13]

Unfortunately, Sometimes we can’t wait.

[dadzone43]

Thank you. I chose RP and THEN read Scholz's book wherein my Blue-level tumor should be treated with RT/ADT. A kick in the teeth for me. I made a good choice. The rest is in the hands of the gods. But your posting is a relief.

[Hidden in reply to dadzone43]

My docs made the same choice for me... just pray it works and it will .. God Bless.

[Hidden]

Great job Patrick. Dont beat yourself up .. go with the professional advice...

[Garbonzeaux]

I am part of this trial and was in the RP group, having the surgery Feb 2018. So far, so good; PSA still undetectable. May it long be so. My choice was partly logistical, since for the radiation, I would have had to move to Houston for awhile. For the RP, it was just a round trip with a few days stay. But I preferred RP anyhow.

Thanks for posting.

[RGD115]

What are your Gleason and PSA readings

[Garbonzeaux in reply to RGD115]

Don't know if you were asking ME this, but my PSA was 5.4 four months before diagnosis (no PSA measurement at Dx time), when I was Gleason 10 (yes) in one of 12 cores. Lupron and taxotere brought me down to 1.1 in 4 months, and continued Lupron and RP brought me to 0.0 in another 3 months.