Surgery performs better than radiotherapy for non-metastatic prostate cancer

Surgery was associated with better survival than radiotherapy in men with non-metastatic prostate cancer, according to a large observational study with follow-up as long as 15 years.

Researchers in Sweden conducted an observational study from 1996 to 2010 among 34,515 men primarily treated for prostate cancer with surgery (n=21,533) or radiotherapy (n=12,982). Patients were categorized by risk group (low, intermediate, high and metastatic), age and Charlson comorbidity score.

Results appeared in BMJ.

Among men with non-metastatic prostate cancer, treatment with radiotherapy was associated with a significantly higher propensity score-adjusted prostate cancer mortality than surgery (subdistribution hazard ratio, 1.76; 95% CI, 1.49 to 2.08). There was no discernible difference in treatment effect among men with metastatic disease, the authors noted. Subgroup analyses showed more clear benefits of surgery among younger and fitter men with intermediate and high-risk disease, and a sensitivity analyses confirmed the main findings.

The researchers noted that younger men and those with less comorbidity who have intermediate- or high-risk localized prostate cancer might see a greater benefit from surgery. The authors wrote, “… our study suggests that surgery might result in improved outcomes compared with radiotherapy in terms of survival for men with non-metastatic prostate cancer, and that radiotherapy seems at least equivalent, and may be superior, to surgery for men with metastatic disease.”