High-Risk Localized Prostate Cancer: Surgery vs. Radiation

This article from the NEJM Journal Watch, Surgery vs.
Radiation Therapy for High-Risk Localized Prostate Cancer High-Risk Localized Prostate Cancer: Surgery vs.
Radiation Review by Allan S.
Brett, MD In an observational study, Radical prostatectomy is associated with lower 5-year mortality
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Patients with high-risk but limited-scope prostate cancer often have a choice between surgery and radiation therapy, but randomized trials comparing outcomes in this patient population are lacking
.

In an observational study, researchers used the Surveillance, Epidemiology, and End Results (SEER) database to analyze 24,000 patients with localized high- or very-high-risk prostate cancer (according to the Johns Hopkins classification method) outcomes of radical prostatectomy and external beam radiotherapy
.

We used propensity score matching to compare cohorts of surgical and radiotherapy patients who were similar in age, Gleason score, clinical stage, and prostate-specific antigen levels
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At 5 years, prostate cancer-specific mortality was significantly lower in the surgery group than in the EBRT group (2.
3% vs.
4.
1%; P<0.
001)
.

These absolute differences were larger in the very high-risk prostate cancer subgroup (3.
5% vs.
6.
0%; P<0.
001) and smaller in the high-risk prostate cancer subgroup (0.
7% vs.
1.
2%; P=0.
22)
.

Comments In this study, the surgery group had a better mortality outcome than the radiotherapy group
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Limitations of this analysis included potential residual confounders and lack of information on use of androgen deprivation therapy, details of radiation regimen, and complications and side effects
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However, due to the current lack of randomized trials, these results serve as background information to guide treatment decisions in patients with high-risk localized prostate cancer
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Reviewed article Chierigo F et al.
Survival after radical prostatectomy versus radiation therapy in high-risk and very high-risk prostate cancer.
J Urol 2022 Feb; 207:375.
(https://doi.
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