Effectiveness of Radical Prostatectomy Versus External Beam Radiation Therapy Plus Brachytherapy in Patients with High-risk Localized PCa.

[pjoshea13]

New study below.

When I opted for Radical Prostatectomy [RP] 14 years ago it was on the basis of 10-year survival (from an online tool that used a half-dozen parameters, including age.

Over the years I have heard oncologists saying that RP is no loger the gold standard, but survival studies continue to show an advantage.

Of course, men undergoing RP tend to be heathier.

"We ... compared OS {overall survival} of EBRT+BT versus RP in comparatively young (≤65yr) and healthy men (Charlson Comorbidity Index=0) with high-risk localized PCa in the National Cancer Database."

"Median follow-up was 92mo (interquartile range 78-108)."

"... EBRT+BT was associated with a higher risk of all-cause mortality compared with RP (hazard ratio=1.22 ...)"

-Patrick

ncbi.nlm.nih.gov/pubmed/304...

Eur Urol. 2018 Nov 9. pii: S0302-2838(18)30820-0. doi: 10.1016/j.eururo.2018.10.032. [Epub ahead of print]

Comparative Effectiveness of Radical Prostatectomy Versus External Beam Radiation Therapy Plus Brachytherapy in Patients with High-risk Localized Prostate Cancer.

Berg S1, Cole AP2, Krimphove MJ3, Nabi J2, Marchese M2, Lipsitz SR4, Noldus J5, Choueiri TK6, Kibel AS2, Trinh QD7.

Author information

1

Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany.

2

Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

3

Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany.

4

Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

5

Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany.

6

Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.

7

Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: [e-mail].

Abstract

A previous study comparing external beam radiation therapy with/without brachytherapy (EBRT±BT) and radical prostatectomy (RP) for high-risk localized prostate cancer (PCa) did not find a difference in overall survival (OS) between the treatments. However, this study was limited by short follow-up and assessment of OS in patients of divergent age and comorbidities. We therefore compared OS of EBRT+BT versus RP in comparatively young (≤65yr) and healthy men (Charlson Comorbidity Index=0) with high-risk localized PCa in the National Cancer Database. Inverse probability of treatment weighting (IPTW) adjustment was used to balance baseline characteristics. Median follow-up was 92mo (interquartile range 78-108). Using IPTW-adjusted Cox regression analysis, EBRT+BT was associated with a higher risk of all-cause mortality compared with RP (hazard ratio=1.22, 95% confidence interval 1.05-1.43). In young and healthy men presenting with high-risk localized PCa, RP showed statistically significant OS benefit compared with EBRT+BT. PATIENT SUMMARY: In an analysis restricted to young and healthy men presenting with high-risk localized prostate cancer, initial radical prostatectomy is associated with an overall survival benefit compared with external beam radiation therapy plus brachytherapy.

KEYWORDS:

Brachytherapy; External beam radiation therapy; Overall survival; Prostate cancer; Radical prostatectomy

PMID: 30420255 DOI: 10.1016/j.eururo.2018.10.032

[cesanon]

Here is the problem. There are so many types of radiation therapy.

And the newer more targetted types can't be well represented in the study. There is a lot of outdated radiation equipment out there that continues to be used with outdated protocols.

And this study is limited to localized prostate cancer as I read it. I am no longer certain what that means any more.

So it is hard for me to get comfort from the results of this study, at least as I understand it.

[pjoshea13 in reply to cesanon]

I am not ruling out the idea that there are individual radiation treatments that do better or as well as RP.

Note that "EBRT+BT was associated with a higher risk of all-cause mortality", & that comes to my problem. RP affects PCa-mortality, but is not known to noticably affect non-PCa mortality. If you recall, Dr Myers became wary of radiation & it's effect on the immune system. It can have adverse effects on the body unrelated to PCa.

-Patrick

[William123Cooper123]

Good reply. More research tends to find cell movement (genetically) into more aggressive, resistant cell types. Can become indolent (or not), and then bloom into lesions (bringing along some hormone sensitive cells ... or not). Difficult to detect, difficult to treat, and the end of the road.

But there are those who disagree with the mutation transformation (EMT?) concept.

• The mutated cells in lesions always remain low?

• Were there all along?

• Are an original cancer cell type.

• Form the lethal type pensions.

• And the tumor genesis is so complex that actually no one knows what’s actually going on (the amount or number of identified cancer cell mutations is great ... which one is the problem? Slug, snail, twist, hedgehog, No. 52, EMT, etc., etc.).

—————

Many researchers are sure EMT occurs (Hedgehog gene for example), EMT but MET has not been noted (very much).

—————

Many tried and true therapies are still tools, with refinements on their mode of actions. (Like we still use penicillin.) New therapies are often experimental, cost a lot, not available, and not covered by insurance. “Give me good old Lupron, a RP, PSA testing, and scans ... as the base or start of my intervention ... then bring out the big guns ... this is a damn, awful disease ... as are all cancers!”

————-

I’m going to die ... but just let it be without pain. (Thank God for opioids.)

[Hidden in reply to William123Cooper123]

Blessed are the pain remedy researchers as well as the PC researchers. I fear pain more than anything.

[HopingForTheBest1]

Those of us who have had genetic testing and have the BRCA2 mutation have limited options, excluding radiation. PARP inhibitors currently in clinical trials, such as Olaparib, have shown positive results. But, they are not yet FDA approved.

[William123Cooper123]

I have been following many research projects regarding 1. Stem cells along, with the/all cancer lesions from mutations, and 2. The pre-existing stem cells already along with the PSA producing cancer cells. You are correct: just one cancer stem cell, and I’m doomed! Research should and has been focusing on indolent hibernating tumors not producing PSA, then growing/spreading/killing? Re-occurrence with no prior detection or issues ... MET is rarely observed. (“I’m a survivor! Yea, Right!) in one, five, ten, 15 years ... damn!

And how to detect (early) those stem-cell cells, control, and kill them. They are like, similar to small-cell lung cancer (for which there in no cure, and a big therapy problem). A lot of work to be done, discarding old theories regarding cancer, and new treatment options that are focused.

My oncologist, urologist, and I did not celebrate “survival” after 5 years with a PSA of (0.00). They were realistic ... yes, I cried when I got home and was alone. (Lord God, just stop me from think about Prostate Cancer one more day! But then there are the three-month Lupron injections and the PSA blood labs. This disease is a bitch!)

[ASAdvocate]

And, here is the opposing study, which shows significantly better PCa-specific survival for radiation than for RP.

jamanetwork.com/journals/ja...

I sure wish that we had some absolutes with this disease.