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Metastatic progression infrequent in low-risk prostate cancer treated with surgery or radiotherapy
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Distant metastases were infrequent in men with low-risk prostate cancer regardless of whether they were treated with radical prostatectomy or external beam radiotherapy. However, researchers found that men with high-risk disease treated with radical prostatectomy had a lower risk for metastatic progression and prostate cancer-specific death than men treated with external beam radiotherapy.
According to background information, there is a lack of data from randomized trials comparing prostatectomy and external beam radiotherapy and their effect on long-term cancer control. In this study, the researchers examined data from a retrospective study comparing men treated with radical prostatectomy (n=1,318) and men treated with external beam radiotherapy (n=1,062) and compared distant metastases data.
Twenty-one patients in the prostatectomy group and 48 patients in the radiotherapy group developed distant metastases. The eight-year probability of freedom from metastasis was similar for both groups: 97% for prostatectomy and 93% for external beam radiotherapy.
After adjustment for factors, including age and treatment year, surgery was associated with a decreased risk for metastasis (HR=0.35; 95% CI, 0.19-0.65). Risk group was the most significant variable linked to metastatic progression, followed by type of treatment.
The adjusted absolute difference in distant metastases-free survival between the two treatments was substantial for high-risk patients with a difference of 7.8% in eight-year metastasis-free survival. Distant metastases-free survival rates were similar for men with low-risk cancer (1.9% difference) and men with intermediate-risk cancer (3.3% difference).
The decreased rates of distant metastasis in patients treated with radical prostatectomy may be related to differences between groups in the use or timing of salvage therapy after documented biochemical failure, according to the researchers.
“Ultimately, for cancers with aggressive phenotypes and high metastatic potential, the integration of more effective systemic therapies with optimal local treatments will be necessary to optimize cause-specific outcomes,” the researchers wrote.
For more information:
- Zelefsky MJ. J Clin Oncol. 2010;doi:10.1200/JCO.2009.22.2265.