Prostatectomy, Radiotherapy Effective Primary Treatments for Prostate Cancer

By Reuters Staff

March 18, 2020

NEW YORK (Reuters Health) - Radical prostatectomy (RP) and radiotherapy (RT) are good primary treatment options for men with high-risk localized and locally advanced prostate cancer, according to a systematic review.

For the 17% to 31% of men with prostate cancer who present with high-risk localized or locally advanced disease, curative treatment provides a survival benefit, but there is no consensus regarding the optimal treatment option.

Dr. Lisa Moris of University Hospitals Leuven and KU Leuven, in Belgium, and colleagues compared the available primary local curative treatment options for high-risk localized and locally advanced prostate cancer at diagnosis. They included 24 randomized clinical trials and 66 nonrandomized studies of more than 367,000 patients in their review.

No curative primary treatment modality bested any other curative treatment in terms of survival.

RP and external beam radiotherapy (EBRT) plus androgen-deprivation therapy (ADT) are suitable options for these patients as long as they are part of a multimodal treatment scheme, the authors write in European Urology.

Multimodal treatment means including radiotherapy with RP and including either hormonal therapy or brachytherapy with radiotherapy.

Adjuvant ADT should be continued for at least 24 months, but comorbidity at the time of diagnosis and treatment-related side effects should be taken into account when deciding on ADT duration.

There is insufficient evidence so far to recommend the use of neoadjuvant and adjuvant chemotherapy with RP or radiotherapy, according to the authors.

The ongoing SPCG-15 prospective randomized study comparing primary RP versus primary radiotherapy plus ADT should help to clarify the optimal local treatment of these men, they add.

Dr. Moris did not respond to a request for comments.

SOURCE: European Urology, online March 4, 2020.