Newswise — New Brunswick, N.J., September 25, 2018 – Newly published results of a study examining men with locally or regionally advanced prostate cancer show those treated with a radical prostatectomy followed by radiation treatment have a lower risk of death from prostate cancer and improved overall survival in comparison to those treated with radiation plus androgen deprivation therapy (ADT).
“While clinical practice guidelines support both of these multimodal strategies for men with advanced prostate cancer, there is little data available from well-controlled studies or randomized trials that compare these substantially different treatment approaches,” notes Thomas L. Jang, MD, MPH, FACS, urologic oncologist at Rutgers Cancer Institute of New Jersey, who led a team of investigators that included other regional collaborators. The work is published in the September 25 online edition of Cancer (doi: 10.1002/cncr.31726).
Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, Dr. Jang and his colleagues identified 13,856 men aged 65 years and older who were diagnosed with locally and regionally advanced prostate cancer between 1992 and 2009, of which 6.1 percent received surgery to remove the prostate followed by radiation and 23.6 percent received radiation plus ADT. At a median follow-up of 14.6 years, there were 2,189 deaths in the cohort, of which 702 were secondary to prostate cancer. Regardless of other variables including cancer stage or Gleason score, men who had radical prostatectomy followed by radiation were less likely to die of prostate cancer compared with those men who received radiation plus ADT. The authors note the survival advantage most benefited those men whose prostate cancer did not spread to the lymph nodes. Higher rates of erectile dysfunction (28 percent versus 20 percent) and urinary incontinence (49 percent versus 19 percent) were noted in those who received radical prostatectomy with radiation when compared to those receiving radiation plus ADT.
“These data suggest that men with high-risk cancers that extend beyond the prostate or spread to regional lymph nodes can achieve durable long-term survival with either treatment approach. The questions should focus not on which treatment modality is best, but instead on optimizing treatment sequences and timing and integrating more effective systemic treatments with optimal local treatments,” adds Jang, who is also an assistant professor of surgery at Rutgers Robert Wood Johnson Medical School.
The authors note study limitations including the usual biases of an observational study design. They add the findings should be verified with prospective trial data and that future clinical trials comparing treatments in this population should include a surgical arm.
Along with Jang, other investigators include Neal Patel, MD, Izak Faiena, MD, Kushan D. Radadia, MD, Dirk F. Moore, PhD, Sammy E. Elsamra, MD, Eric A Singer, MD, MA, Mark N. Stein, MD, Yong Lin, PhD and Isaac Y. Kim, MD, PhD, MBA, all Rutgers Cancer Institute and Rutgers Robert Wood Johnson Medical School; James A. Eastham, MD and Peter T. Scardino, MD, both of Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York; and Grace L. Lu-Yao, PhD, MPH, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia.
Jang acknowledges support for this work by the New Jersey Health Foundation, while Lu-Yao is supported by the National Cancer Institute (NCI) (CA-116399). The Rutgers Cancer Institute Biometrics Shared Resource is supported by the NCI (P30 CA-072720). The authors acknowledge the efforts of the NCI, the Centers for Medicare and Medicaid Services, Information Management Services, Inc., and the Surveillance, Epidemiology and End Results (SEER) tumor registries in the creation of the SEER-Medicare database. Additional details including information on conflicts of interest can be found at: doi: 10.1002/cncr.31726.
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