Surgery vs RT vs ADT

[JimmyToowong]

Editorial - Comparative risk-adjusted mortality outcomes after primary surgery, radiotherapy, or androgen-deprivation therapy for localized prostate cancer

BERKELEY, CA (UroToday.com) - In the online edition of Cancer, Dr. Matthew Cooperberg and colleagues report that after adjustment for tumor and clinical variables, survival outcomes for patients treated with radical prostatectomy (RP) for prostate cancer (CaP) exceed those treated with radiotherapy or androgen-deprivation therapy (ADT). The data came from CaPSURE, a national registry for men with CaP that is collected at 40 clinical sites, the majority of which are community-based). Patients are treated according to their physicians’ usual practices and followed longitudinally. Cancer specific mortality (CSM) is determined if CaP is listed as a primary, secondary or tertiary cause of death on the death certificate. All-cause mortality was also assessed. From the database, 8,982 men with localized CaP underwent treatment and 7,538 had data sufficient for this analysis. The data was analyzed by two risk-adjustment approaches - the Kattan nomogram and the CAPRA instrument. A hazard ratio (HR) was calculated for radiation and ADT and compared with RP. The researchers adjusted for neoadjuvant ADT, but this did not alter the model.

In total, 1,293 men (17.2%) died, and this included 226 deaths from CaP (3%). Analysis demonstrated that patients undergoing RP were younger, had less comorbidities and lower risk disease than those treated with radiotherapy or ADT. Approximately half of patients receiving radiotherapy also received neoadjuvant and/or adjuvant ADT. For men who underwent RP, 6.7% received neoadjuvant ADT for a mean duration of 7.9 months. The median follow-up durations were similar among treatment groups and risk categories. They report that after adjustment for age and risk, the CSM hazard ratios compared with RP were 2.21 for radiotherapy and 3.22 for ADT. The CSM hazard ratios for ADT relative to radiotherapy was 1.45. Results remained similar when adjusting risk using the CAPRA instrument instead of the Kattan nomogram. Exclusion of patients who had radiotherapy following RP did not alter the findings. All cause mortality (ACM) after adjustment for age, risk, and comorbidity revealed an HR relative to RP of 1.58 for radiotherapy and 2.25 for ADT. The 10-year CSM increased with increasing CAPRA risk from 1.5% to 32.8% for RP, from 2.5% to 48.7% for radiotherapy, and from 4.0% to 66.3% for ADT. Using more contemporary data from 1998 onwards found the HR for CSM relative to RP to be 2.7 for radiotherapy and 6.5 for ADT.

While no randomized trials have been reported that compare these CaP treatments in a prospective study, this unique report after adjustment for patient age, comorbidities, and risk category reveals superior survival outcomes for patients treated with RP compared with radiotherapy or ADT.

{{jm: The weakness of this study is while there may have been some improvements in surgery, there have been massive improvements in radiotherapy. The modern high doses used make a very large difference. Stone et al. studied 3928 men on high or low dose radiation. After 7 years, about 19% of the men on the low dose radiation were free of rising PSA, compared to about 90% of the high dose men.

And very recently the results are through one radiation + ADT : ADT improves radiation results, radiation improves ADT results.

For a 2011 expert summary of 18,000 published prostate cancer treatment articles,

http://www.prostate-cancer.org/pcricms/ ... _p3-11.pdf

or search Google for "all the modern prostate cancer literature and treatment results"

(include the double quotes).}

Cooperberg MR, Vickers AJ, Broering JM, Carroll PR

Cancer. 2010 Aug 5. Epub ahead of print.[1]

10.1002/cncr.25456

PMID: 20690197 Forum: Primary hormone therapy Title: Surgery vs RT vs ADT

This extract can be found on http://PubMed.com, and is in the public domain.

On PubMed.com there will be a link to the full paper (often $30, sometimes free).

Any highlighting (except the title) is not by the author, but by Jim Marshall.

Jim is not a doctor.

This page was found on the Advanced Prostate Cancer Community for Australian men at http://advancedprost...lia.ipbhost.com.

The link is hard to remember.

An easier way to find it is to go to JimJimJimJim.com and click on Prostate.

That's the word Jim four times, no spaces, followed by .com.

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Click on the Contact Jim button at http://JimJimJimJim.com.