1: High dose radiation as effective as radical prostatectomy for aggressive prostate cancer

In a study published this month in the European Journal of Urology, researchers from UCLA performed a retrospective analysis to compare the outcomes for 487 men with Gleason scores of 9 or 10 treated with either radiation or surgery. Clinical outcomes were measured for men treated between 2000-2013 with either EBRT (extremely-dose escalated radiotherapy) [230 men], EBRT + BT (Brachytherapy) [87 men] or RP (radical prostatectomy) [170 men], with a median follow-up of 4.6 years.

While 5-yr and 10-yr cancer specific survival and overall survival was similar for all three treatment groups, there was a significant increase in 5-yr and 10-yr distant metastasis-free survival in men who received EBRT + BT (94.6%, 89.8%) compared to EBRT alone (78.7%, 66.7%, p<0.0005) or RP (79.1%, 61.5%, p<0.0001). In addition, there was increased local and systemic salvage associated with RP (49.0%, 30.1%) compared to EBRT (0.9%, 19.7%) or EBRT + BT (1.2%, 16.1%, p<0.001).

This study provides both clinicians and patients with more evidence about the efficiency of these common treatments and indicates that while both radiation and surgery are effective treatments for aggressive prostate cancer, EBRT + BT may provide the best chance of preventing metastatic disease.

2: Addition of radiotherapy to hormone therapy increases survival in men with newly diagnosed metastatic prostate cancer

Androgen deprivation therapy (ADT) is first line therapy for newly diagnosed metatastic prostate cancer (mPCa). Following up on recent studies that have shown improved survival when ADT is combined with prostatectomy, an American study published in the Journal of Clinical Oncology has examined the benefits of combining ADT with radiotherapy (RT). 6382 men were identified within the National Cancer Database (NCDB) who were diagnosed with mPCA between 2004 and 2012. Of these, 538 men received RT. With a median follow-up of 5.1 years, there was significantly improved overall survival for men receiving RT + ADT compared to ADT alone (hazard ratio, 0.624; 95% CI, 0.551-0.706; p<0.001).

Analysis of a sub-set of long-term survivors showed increased overall survival at ≥1, ≥3 and ≥5 years (all p<0.05) with the addition of RT to ADT. There was no difference in overall survival between Prostatectomy + ADT compared to RT + ADT, while both combinations were superior to ADT alone. This study adds to growing evidence supporting the use of ADT in combination with local treatment strategies such as surgery or RT.

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