Leading treatments for localized prostate cancer yield similar results

The outcomes of early stage prostate cancer are good regardless of treatment modality chosen, investigators report in the April issue of Radiotherapy and Oncology. So quality of life issues may be the most important factor in considering external beam radiotherapy, radical prostatectomy or permanent seed implantation.

There have been no large, head-to-head comparisons of the three treatment approaches, explains lead author Dr. Louis Potters, of the New York Prostate Institute in Oceanside, and his associates. They therefore compared freedom from biochemical recurrence (FBR) rates as determined by prostate specific antigen (PSA) levels among 1819 consecutive cases of stage T1 or T2 adenocarcinoma treated between 1992 and 1998. During median follow-up of 58 months, estimated 7-year FBR rates were 79% in the surgery group (n = 746), 77% in the external beam radiotherapy group (n = 340) and 74% in the brachytherapy group (n = 733).In multivariate analysis, only pretreatment PSA levels and Gleason scores were independent predictors of FBR (p < 0.0001 for both). Outcomes were not significantly associated with age, race, clinical stage or treatment approach.The impact of the differential effects caused by adjuvant therapy remains unclear, Dr. Potters told Reuters Health. But even though their study looked only at monotherapy, "the bias against any one treatment not receiving adjuvant therapy goes against all three of them."He advises that treatment decisions be based on "avenue of least regret" in terms of erectile function and urinary and rectal outcomes."For patients who strongly feel that the cancer should be cut out regardless of side effects, they should be treated with radical prostatectomy," he explained. "When patients are afraid of the consequences of surgery," radiation is probably appropriate for those who are not highly symptomatic or have not undergone transurethral resection of the prostate."I literally tell them, 'Think of yourself 5 years from now. Will you regret your decision then?'"His group expects to look at other end points of treatment, such as development of metastases and disease-specific survival, after longer follow-up in the same patient cohort. "We also want to assess the meaning of biochemical failure and if there are ways to subselect patients who need aggressive salvage therapy versus watchful waiting."(Source: Radiother Oncol 2004;71:29-33: Reuters Health: Karla Gale: Oncolink: April 2004)