Surgery offers better survival rate in prostate cancer
Surgical treatment offers better survival rates than radiotherapy for men with clinically localised prostate cancer, according to one of the largest studies of its type. Researchers in Oxford, Stockholm, and the Netherlands compared data from more than 34,000 patients in Sweden over a 15-year period.
Around 350,000 men are diagnosed with prostate cancer in Europe each year and the lifetime risk of being diagnosed is one in six. It is hoped the results of the study, published online in the British Medical Journal, could help inform in the choice of appropriate treatment. The study show that patients in an intermediate or high risk group who had surgery as their primary treatment had an increased survival rate. Benefits for surgery were also seen in low risk prostate cancer patients but these men tended to do well whatever treatment they received. Further, the greatest benefits for surgery over radiotherapy were seen in younger men and those in better general health as these men were less likely to succumb to death from other causes and thus their prostate cancer became a life-threatening issue for them.
The decision on whether to have surgery or radiotherapy is one for the patient and their consultant, at present without clear evidence to compare the merits of each in survival terms. Surgical treatment of prostate cancer is by radical prostatectomy, a procedure to remove the prostate gland. This can now be performed using robotic keyhole surgery. However, common side-effects are still impotence and urinary incontinence. Radical radiotherapy treatment involves giving a high dose of radiation to the prostate gland, damaging DNA in the tumour cells and thus preventing tumour growth.
“Although we hope this study will play an important part in informing the decision-making process of the individual patient and his doctor, we only looked at length of life and that is only one consideration in choosing a treatment option, comments lead author Prasanna Sooriakumaran, a senior clinical researcher at Oxford University and visiting assistant professor at Karolinska Institutet. “The side effects of different treatments will affect quality of life in different ways and some patients will value certain quality of life advantages for one treatment option as being more important than length of life.
In this study virtually all men with prostate cancer diagnosed in Sweden from 1998 onwards were followed for up to 15 years. Data from the National Prostate Cancer Registry of Sweden was merged with eight other Swedish national datasets including the Inpatient and Cause of Death registries to obtain complete and accurate information of important characteristics like tumour type, grade, stage, age, medical history, and socioeconomic status.
“The Swedish dataset we employed in this study is the world’s most comprehensive and accurate data in survival outcomes for men with prostate cancer”, says Peter Wiklund, the study’s senior author and a professor at Karolinska Institutet. “We are confident in the robustness of our findings, but we must remember that the demographic make-up of Sweden is different to that of many parts of the world including the USA and UK, and thus how these results apply to different patient populations is yet to be determined.”
The researchers from Oxford University’s Nuffield Department of Surgical Sciences, the Department of Molecular Medicine and Surgery at the Karolinska Institutet in Stockholm, and the Department of Epidemiology at Erasmus University in the Netherlands, were supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre and the Swedish Research Council.
Comparative oncological effectiveness of radical prostatectomy and radiotherapy in prostate cancer: an analysis of mortality outcomes in 34,515 patients treated with up to 15 years follow-up
P. Sooriakumaran, T. Nyberg, Tommy, O. Akre, L. Haendler, I. Heus, M. Olsson, S. Carlsson, M. Roobol, G. Steineck, and P. Wiklund
British Medical Journal, online 27 February 2014, doi: 10.1136/bmj.g1502