Not all treatments for early prostate cancer equally effective: study

Categories: Prostate Cancer

An analysis of men with early prostate cancer treated at the Cleveland Clinic found that those treated with external beam radiation therapy had poorer overall survival than those treated with radioactive seed implants (brachytherapy) or radical prostatectomy. The findings persisted after controlling for potentially confounding factors such as age, comorbidities, and smoking history.

“These findings indicate that the three major forms of treatment for early-stage prostate cancer are not necessarily equivalent in terms of overall survival,” said Dr. Jay Ciezki of the Cleveland Clinic in a statement. He presented the results Saturday in Orlando at the at The Prostate Cancer Symposium, co-sponsored by the American Society of Clinical Oncology, the American Society of Therapeutic Radiology and Oncology, and the Society of Urologic Oncology.

From 1996 to 2003, 2,285 men with low- or intermediate-risk prostate cancer were treated at the Cleveland Clinic with either brachytherapy (n = 662), external beam radiotherapy (n = 570), or radical prostatectomy (n = 1053). They’ve been followed for a median of 59 months (range: 24-119 months).

After 5 years, overall survival rates are 93.8% for men treated with external beam radiotherapy compared with 95.7% for men treated with brachytherapy and 97.7% for those treated with surgery. “Overall survival rates for patients treated with external beam radiation were 2% lower across the entire length of follow up,” Dr. Ciezki said at a press briefing.

In multivariate analysis, brachytherapy and surgery were equivalent in terms of overall survival, while radiotherapy remained less effective.

Dr. Eric Klein of the Cleveland Clinic, who moderated the press briefing, said: “We really are not sure why we are seeing this. Jay did a nice job at looking at the typical reasons for differences between outcomes in overall survival, which is comorbidities, and comorbidities did not explain the differences.”

“There is something biologic going on here but we don’t understand it yet,” Dr. Klein added.

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