There's an interesting paper I came across at the ASCO (American Society of Clinical Oncology) 2025 symposium that has just taken place. This was session 309 - Radical prostatectomy (RP) versus radiotherapy (RT) in high-risk prostate cancer (HR-PCa): Emulated randomized comparison with individual patient data (IPD) from two phase III randomized trials (RCTs).
then prostate cancer localised and it's on the 2nd page.
To avoid the bias that usually happens comparing the two treatments, they took existing RCTs and extracted data from them.
In a nutshell, distant mets (DM) were significantly lower in patients who underwent RT compared to RP (8-year DM: 16% vs 23%). 8-year rates of death after DM were 10% vs 8% (p=0.72) in the RP and RT patients, respectively. The RT results may be even better as the deaths without DM were higher in the RT group as they were older - so a significant number of the RT group who died after DM would have been from other causes though this does require further analysis.
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MarkS
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As someone who was treated with SBRT for prostate cancer I am glad to see favorable information. However a different study in patients diagnosed incidentally from procedures like TURP showed surprisingly opposite. It is very surprising as most would think radiation especially in higher grade Gleason scores would be better. The divide continues and seems to never end--maybe they are pretty equal as has been said in past. I don't know but am happy with my radiation SBRT for Gleason 8.The summary was below with reference.
Incidental PCa RT-treated patients exhibited less favorable clinical characteristics than their RP counterparts. Despite full adjustment, RP was associated with a protective effect relative to RT. This effect exclusively applied to the Gleason sum 8-10 subgroup. In consequence, IPCa patients harboring Gleason sum 8-10 should ideally be considered for RP instead of RT.
Urologic oncology. 2025 Jan 17 [Epub ahead of print]
Francesco Di Bello, Lukas Scheipner, Andrea Baudo, Mario de Angelis, Letizia Maria Ippolita Jannello, Carolin Siech, Zhe Tian, Kira Vitucci, Jordan A Goyal, Claudia Collà Ruvolo, Gianluigi Califano, Massimiliano Creta, Simone Morra, Pietro Acquati, Fred Saad, Shahrokh F Shariat, Luca Carmignani, Ottavio de Cobelli, Sascha Ahyai, Alberto Briganti, Felix K H Chun, Nicola Longo, Pierre I Karakiewic
The two cohorts seem entirely different - the RT cohort had over 4 times more patients with Gleason 8-10, were 8 years older on average and over half the RP cohort were G6. G8-9 has around 16 times more risk than G6. The authors say they allowed for this, but with such wide differences between the two cohorts, I think that is an impossible task.
Also the data was from 2004 to 2015. In the meantime RT has come on in leaps and bounds, and RP has hardly changed. There is no description of the type of RT carried out or whether ADT was included - I suspect not. Furthermore, the writers were mainly from departments of urology so they would naturally favour the urology solution.
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Survival after Radical Prostatectomy versus Radiation Therapy in High-Risk and Very High-Risk Prostate Cancer
My urologist after RT and ADT
Active surveillance has ended after one year. RP now recommended.
More on RP vs. "watchful waiting"
