Younger men with high-grade prostate cancer are more likely to die of prostate cancer than from other causes. This is due to their age and longer life expectancy, which allows the more aggressive prostate cancer to grow over time. Previous studies have conflicting results regarding the best initial treatment for men in this category, and thus debate continues over the appropriate way to treat men with this type of prostate cancer.
The new study found that radical prostatectomy led to a benefit in both prostate cancer-specific and overall survival. The men who had surgery as their initial treatment had a 63% reduction in prostate cancer-specific death, when compared to men who had radiation as their first treatment. Men in the surgery group also had a 59% reduction in overall mortality.
The analysis included data on 2,228 men, 65.5% of whom had surgery as initial treatment, and 34.5% of whom had external beam radiation therapy. Men in both groups had been diagnosed with Gleason 8 to 10 prostate cancer, but the disease had not yet spread outside the prostate to the lymph nodes or further.
The authors of the new study wrote that future prospective randomized trials are needed to confirm the long-term outcomes of surgery and radiation for men younger than 60 years diagnosed with localized, high-grade prostate cancer.
J Urol. 2019 Jan;201(1):120-128. doi: 10.1016/j.juro.2018.07.049.