Survival after Radical Prostatectomy versus Radiation Therapy in High-Risk and Very High-Risk Prostate Cancer

[maley2711]

This just appeared in today's email. Apparently a database study of patients treated 2010-2016. At 5 years out, RP less cancer-specific mortality than RT.....the most significant advantage for very high-risk men.

pubmed.ncbi.nlm.nih.gov/345...

Not a randomized study, but will we ever have anything better when making such a comparison? Does the propensity score matching do anything to address the confounding factors questions ? Does this study do anything to put into question that RP and RT have equivalent results for the high/very high risk groups?

[cesces]

I thought Tall Allen had data that showed radiation treatment was superior to radical prostatectomy?

[Don_1213 in reply to cesces]

TA suggests that radiation and brachy have been long-term results for HR and VHR patients than radiation alone or radical prostatectomy.

[Justfor_]

Don't expect any indisputable proof in times of PC*. Everything is equal to anything else.

(*)PC here doesn't stand for Prostate Cancer but Political Correctness.

[Don_1213]

The question of confounding factors (health, age, etc) made me question this retrospective study. I'd love to see a graph for overall CSM vs age of the subjects (and their treatment) and then CSM and time from initiation of treatment. It would seem that would be data easily available and might give some clue as to confounding factors having an effect on the mortality vs treatment.

[maley2711 in reply to Don_1213]

If you read the full study, patients were matched 1:1 for age, GS, PSA,etc....Of the 25,000 total, only 7000 + 7000 used for statistical analysis. There was also some manipulation done to account for comorbidities as determined by other cause deaths.

[Don_1213]

BTW - here is a link to the full article: auajournals.org/doi/10.1097...

I note that they excluded anyone who had brachy or EBRT/Brachy-boost. And in their conclusions, they state that while they tried to take into account other factors like age, GS, other morbidity factors - that might not have actually been sufficient. Interestingly, they also state ("Forth" in conclusions) that they found no difference in results for high-risk John Hopkins patients comparing EBRT and RP.

Other data that was missing (or not noted that I could find) were the differences resulting from additional treatments such as ADT or chemo. They didn't state that these patients were excluded or included that I could find, there actually was no mention at all that I could find.

We also are looking at EBRT of probably 10-15 years ago which is greatly different from what is standard practice today.

The entire study left me scratching my head trying to think of any value that is actually has today. I couldn't come up with any..

[conbio in reply to Don_1213]

Thanks - That was my reaction as well - a bit dated. And given that for high risk PC the current approach includes RT-ADT-Brachy --- I don't see much usefulness in this look back at older technology and a mono therapy.

[maley2711 in reply to conbio]

NCCN guidelines for high risk include surgery EBRT + ADT, and brachy boost. I have been offered surgery or IMRT + ADT. Brachy is not readily available, from experienced ROs, thruout this country. In the US, surgery procedures are increasing for high risk. JUst my guess..... as I look into the abyss........ADT scares the hell out of many men!! Brachy boost comes the combo side effects. Brachy boost is not the current approach in general practice.

[conbio in reply to maley2711]

My practitioner at University of Washington/Seattle Cancer Care Alliance has done well over 1,000 of these procedures (brachy) in his 30 years of practice - so far my ADT experience has been decent (libido very low, some hot flashes) -- still rock climbing, ski mountaineering, mountain biking - 65 yo. The long term outcome for RP for my cancer was scarier than my choice. Cheers.

[maley2711 in reply to conbio]

Congrats on your outcome. You are lucky to have such a brachy pro at a convenient location for you! Anecdotes don't take the place of studies, and the results of studies do not predict an outcome for any patient for any treatment...studies only give us a probability of a certain outcome...zero guarantee of course. what I said still stands re NCCN guidelines, which do include brachy boost, but not exclusively. availability of highly expert brachy Docs and increased SE PROBABILITIES are the issues. I ended up with a 1 week catheter as a result of an 18 core biopsy...probability of that was low, but didn't help me!! I of course would fear an even more invasive brachy procedure and what might follow re need for catheter. Unlike you, I am not a superb physical specimen at 73.

[Don_1213]

Interesting, but perhaps not unexpected - if you click on the authors, there is an option to view info on all the authors. Takes a few clicks. As far as I could see - they were all either urologists or surgeons. No radiation oncologists at all. Funny about that..

[cesces in reply to Don_1213]

"they were all either urologists or surgeons. No radiation oncologists at all"

Ahhh. That's the confounding factor.

[maley2711 in reply to cesces]

Might there be a defensive bias being expressed in this forum? The differences weren't that large.....perhaps insufficient to "prove" superiority of either. Since we'll never havea random study, there will always be uncertainty......I have never seen a retrospective study showing superiority of RT...but confounding factors. MY RO doesn't make any claims!!

[JayMot in reply to maley2711]

Haha, think so? Don't like the results, discredit the authors. lol Data is data.