Patients with prostate cancer should fully discuss treatment options

Overall and cancer-specific control is shown to be better in patients with localized prostate cancer who underwent surgical treatment compared to radiation treatment, concludes a Sunnybrook-led report published in European Urology.

The report compared two key treatment options for patients with clinically localized prostate cancer (confined to the prostate gland), namely radical prostatectomy surgery and contemporary forms of radiation therapy.

“As emphasized in current clinical guidelines, both treatment approaches should be discussed with eligible patients prior to the start of either therapy,” says Dr. Robert Nam, lead investigator, uro-oncologist, and head of the Genitourinary Cancer Care team at Sunnybrook’s Odette Cancer Centre. “Our research now gives physicians and patients more data to consider when making the decision about choice of therapy.”

“An individual’s age and any pre-existing medical conditions should also be a part of that fulsome discussion,” says Dr. Nam, who is also a professor in the Department of Surgery at the University of Toronto.

The researchers conducted a systematic review and meta-analysis of 19 studies published up to June 2015 that were objectively selected, and involved unique cohorts or groups of patients per study, resulting in a cumulative review of 118,830 patients who underwent treatment with either surgery or radiation and that had all important factors that would affect survival.

Results showed consistently better overall and prostate cancer-specific control in patients treated with surgery compared to radiation therapy. The researchers also conducted subgroup analyses of the data by risk group (severity of the cancer), radiation regimen, time period (earlier vs. later), and follow-up time, which showed similar results. In particular, surgery was found to have better results among patients with the most aggressive types of cancer, or when compared to current forms of radiation treatment.

An estimated 24,000 men will be diagnosed this year with prostate cancer, according to the Canadian Cancer Society. About 80 per cent or 19,200 of these cases will be a localized prostate cancer diagnosis.