Surgery increases survival for high-risk prostate cancer

A new study by researchers at the University of California
San Francisco show that men with high-risk prostate cancer
survive longer with prostate surgery.

SAN FRANCISCO – Cancer Digest – Men treated with surgery for localized prostate cancer with a high risk of recurrence or spread had significantly higher survival rate than men treated with either external-beam radiation or hormonal therapies, a new study shows.

Led by Dr. Matthew Cooperberg, lead investigator of the study and a prostate cancer specialist in the UCSF Department of Urology, the researchers found that the differences among therapies were greater at higher levels of cancer risk, and suggest, the researchers say, that in many cases surgery should play a greater role in treatment strategies for patients with prostate cancer that is likely to recur or spread. 

“These therapies can all have significant side effects, so it’s important to understand which treatment alternatives are most effective," Cooperberg said in a prepared statement. "In current practice, likelihood of undergoing surgery falls progressively with increasing levels of risk, which may be exactly contrary to what the treatment pattern should be.” The study appeared online this week in the journal Cancer ahead of print publication.

The researchers say most previous studies comparing outcomes among different treatments looked only at PSA responses to treatment, rather than at long-term survival. Measuring levels of PSA, or prostate-specific antigen, in the blood, is intended to help determine whether prostate cancer has recurred or spread, although in many cases a rising PSA level does not necessarily mean the cancer will progress.

The researchers analyzed data from 7,538 men with localized disease from the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry, a national disease registry comprising men from 40 urologic practice sites from across the country. The team then compared outcomes across treatments after adjusting for risk and age. In total, 266 men died of prostate cancer during the study follow-up.

They found that the risk of dying of prostate cancer was more than three times higher in patients who received hormone therapy versus surgical removal of the prostate, or radical prostatectomy. The mortality risk was more than twice as high in patients who received external-beam radiation therapy compared to prostatectomy.

For men at low levels of risk, prostate cancer mortality was very uncommon, and differences among the treatment options were small. The survival differences increased substantially for men at intermediate and high risk, according to the analysis, with the greatest relative benefit for surgery seen for men at higher levels of risk.

“This is a clear signal to the physician community that prostatectomy should be considered for men with higher-risk prostate cancer,” said Dr. Peter Carroll, chair of the UCSF Department of Urology and leader of the Prostate Program at the UCSF Helen Diller Family Comprehensive Cancer Center.

“In many cases, surgery would be part of a multimodal treatment approach, including adjuvant radiation or systemic treatments based on the pathology and early PSA response,” added Carroll, who is senior author on the paper.

SOURCE: press materials provided by University of California San Francisco, and the journal Cancer.