Three leading prostate cancer treatments have similar outcomes, study finds

PSA Rising, New York. April 24 2004. -- A seven-year study of more than 1800 early-stage prostate cancer patients treated solely with either radical prostatectomy, external beam radiation therapy, or brachytherapy (in which radioactive seeds are implanted into the prostate), showed statistically similar outcomes with each of the treatment options.

This is one of the largest head-to-head studies to date and included patients from the Cleveland Clinic Foundation (1178 patients) and Memorial Sloan Kettering on Long Island (641 patients). Lead author Dr. Louis Potters was chief of radiation oncology at Memorial Sloan-Kettering Cancer Center's Mercy Hospital, New York, at the time of this study.

The study in the April issue of Radiotherapy and Oncology compared 746 radical prostatectomy (RP), 340 external beam radiation therapy (RT) and 732 prostate brachytherapy (PB) patients with T-1 and T-2 localized tumors. About three-quarters of the patients in each treatment group had an initial prostate-specific antigen (PSA) level of 10 ng/ml or less and a Gleason score of six or below.

All three treatment groups had statistically similar outcomes at seven years. According to the authors, this study indicates that prostate cancer with these stages of the disease patients can expect "generally excellent" results regardless of their treatment choice.

Comparison of treatments for prostate cancer is complicated because patients in many studies are treated with more than one therapeutic option. When hormonal therapy, for example, is used before radiotherapy or radical prostatectomy, it is harder to compare the main options, brachytherapy, external radiation or radical prostatectomy.

All the patients in this study received a single therapy, allowing direct comparison of the treatment options.

All the patients were treated at some time between 1992 and 1998. They were followed up for a median of 58 months for all cases (51 months for PPB cases, 56 months for RT cases, and 64 months for RP cases).

Biochemical relapse was defined as any detectable PSA value greater than 0.2 ng/ml for patients receiving RP, or three consecutive PSA value rises for those receiving EBRT or PI.

Seven year success rates, measured as freedom from biological relapse, were closely similar for all three treatments, as follows:

Brachytherapy, 74% success.
External beam radiotherapy, 77%.
Radical prostatectomy, 79%.

Multivariate analysis identified initial PSA and biopsy Gleason score as independent predictors of relapse. Type of treatment, age, clinical T-stage, and race were not independent predictors of failure.

It is important to note than in a related study, Dr. Potters' team found that patients who receive a low-dose of external beam radiation (below 72 Gy) have "significantly worse" outcomes than those who receive a dose above 72 Gy.

"This study is important because we have not seen any randomized data for patients with clinically localized prostate cancer treated with just one therapy," Dr. Potters said. "The fact that the study was unencumbered by mixing treatments and that there was sufficient follow-up in each study group, strengthens the power of the results," he said.

Urologists often consider RP the gold standard treatment, but this rather large study bolsters existing research that shows similar results with brachytherapy or external beam radiation.

Patients should compare treatment side effects and put them in the balance, Potters said, since outcomes are similar, regardless of the decision. "The study indicates patients with clinically localized disease should choose their personal avenue of least regret."

Study title: Monotherapy for stage T1-T2 prostate cancer: Radical prostatectomy, external beam radiotherapy, or permanent seed implantation, Radiotherapy and Oncology, Vol 71/1 pp 29-33, 2004.

This page reported by J. Strax, last updated April 22, 2004

Source: ASTRO ((American Society for Therapeutic Radiology Oncology) and New York Prostate Institute

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