Is surgery or radiation more effective in treating aggressive prostate cancer?

A study compared the effectiveness of surgery and postoperative radiation therapy compared to surgery alone in treating aggressive prostate cancer.

Treatment for prostate cancer varies depending on the progression of the disease, which can be graded by assessing biopsied tissue using the Gleason score.  Tumours of patients with Gleason scores of 9 to 10 are highly aggressive and comprise the majority of prostate cancer-related deaths. Despite undergoing surgical removal of the prostate, up to 80% of patients in this category are expected to have a recurrence of cancer, at which point they undergo radiation and hormone therapy.

A team of German and American researchers recently carried out a study comparing the effectiveness of treating aggressive prostate cancer with surgery and postoperative radiation/hormone therapy compared to treatment with surgery alone. A total of 639 men with Gleason scores of 9 or 10 were enrolled in the study, which was published in JAMA Oncology.

The researchers found that approximately 1 in 10 patients treated with radiation and hormone therapy following surgery were likely to die within five years of treatment compared to one in five patients who underwent surgery alone.

Radiation and hormone therapy may not always be initiated immediately after surgery due to concerns about overtreating patients. However, the researchers suggest that these concerns should be reconsidered given the high rate of recurrence in patients with aggressive prostate cancer.

Written by Agustin Dominguez Iino, BSc

References:

1. Tilki D, Chen MH, Wu J, Huland H, Graefen M, Braccioforte M, Moran BJ, D’Amico AV. Surgery vs Radiotherapy in the Management of Biopsy Gleason Score 9-10 Prostate Cancer and the Risk of Mortality. JAMA Oncol. 2018 Nov 15. doi: 10.1001/jamaoncol.2018.4836. [Epub ahead of print]
2. Surgery & combination therapy optimises results in aggressive prostate cancer management. Oncology News Australia. http://oncologynews.com.au/surgery-combination-therapy-optimises-results-in-aggressive-prostate-cancer-management/. Published November 19, 2018.