The optimal strategy for treating newly diagnosed high-risk prostate cancer remains unclear. More specifically, do these patients benefit more from radical prostatectomy or a radiotherapy-based approach?
A recent analysis aimed to help clarify the uncertainty.
The study, which evaluated individual patient data from two large contemporary randomized controlled trials, appeared to favor a radiotherapy-based treatment strategy over a surgery-based approach in this patient population. Compared with radical prostatectomy followed by personalized postoperative therapy, radiotherapy plus androgen deprivation therapy (ADT) was associated with a 32% relative reduction in distant metastases at 8 years.
However, the risk for death after distant spread was similar between the two strategies.
Overall, “we think this study moves the needle but does not end the debate,” corresponding author Daniel E. Spratt, MD, Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, told Medscape Medical News.
“While it’s not a head-to-head randomized trial between surgery and radiation plus ADT, it provides compelling comparative data suggesting that radiotherapy plus ADT may not just be equivalent — it might be better when it comes to controlling disease and reducing treatment escalation,” Spratt explained.
William K. Kelly, DO, however, had a different take.
“The question still has not been answered,” given that there was no difference in overall cancer-specific survival, said Kelly, chair of medical oncology, Thomas Jefferson University Hospital, Philadelphia, who wasn’t involved in the analysis.
