Radical prostatectomy and radiation therapy are associated with improved survival in men with metastatic prostate cancer, according to a new study.
"Since prospective, randomized trials are the best source for providing evidence and treatment changes, our retrospective study can be used for setting up randomized trials, addressing exactly this topic: Do patients benefit from local treatment even in metastatic disease?” said Dr. Sami-Ramzi Leyh-Bannurah from the University of Montreal Health Center, in Canada, and the Prostate Cancer Center Hamburg-Eppendorf, in Hamburg, Germany.
“Since we do not have such Level I evidence, local treatment in metastatic disease should still be considered as experimental,” he told Reuters Health by email.
The current standard of care for metastatic prostate cancer is androgen deprivation therapy with no local therapy, but several studies have reported improved survival with local therapy.
Dr. Leyh-Bannurah and colleagues used data from the Surveillance, Epidemiology and End Results (SEER) database to examine cancer-specific mortality according to local therapy, including radical prostatectomy (RP) and radiotherapy (RT), versus no local therapy in more than 13,000 men diagnosed with metastatic prostate cancer between 2004 and 2013.
In propensity-score-matched multivariable competing-risk regression analyses, cancer-specific mortality rates were 65% lower after RP and 52% lower after RT compared with no local therapy (both p<0 .001="" 3.="" april="" european="" in="" online="" p="" report="" researchers="" the="" urology="">
Risk factors for higher cancer-specific mortality included Gleason >=8, clinical T stage 4 and substage M1c, and divorced/widowed marital status.
RT and RP had strong protective effects in patients with 0 or 1 risk criterion, but they were less effective in patients with two or more risk criteria.
“During the last decade, a paradigm shift in prostate cancer treatment occurred,” Dr. Leyh-Bannurah said. “Low-risk patients undergo active surveillance regimes or focal treatment approaches. On the other hand, more advanced disease is increasingly treated by radical prostatectomy in the setting of multimodal therapy approaches, e.g., RP followed by radiotherapy and/or androgen deprivation. Similarly, hormone-naive, non-castration-resistant, metastatic-prostate-cancer patients are increasingly treated with docetaxel-based chemotherapy.”
Dr. Anthony Turpin from CHRU de Lille, in France, who recently assessed real-life practices among physicians who treat patients with metastatic castrate-resistant prostate cancer, told Reuters Health by email, "In metastatic prostate cancer, these data reinforce the interest of local treatment, especially in low-tumor-burden or low-aggressiveness prostate cancer. If both options of local treatment are possible (surgery vs. radiotherapy), surgery seems to give better results on survival, but there is no notion of quality of life in this study.”
“Nevertheless, data are retrospective,” he said. “Although the methodology is better than the existing retrospective series with calculating a propensity score, it should remain cautious. It is necessary to wait for data from current clinical trials.”