Traditionally, these high-risk patients are treated with radiation therapy plus androgen-deprivation therapy (ADT) due to the risk of positive surgical margins or distant relapse after radical prostatectomy.
Recently, a large retrospective study compared results for men with advanced prostate cancer who either had a radical prostatectomy followed by radiation therapy, or who underwent radiation therapy plus ADT.
At 10 years after treatment, the adjusted overall survival rate was better in men who had prostatectomies followed by radiation therapy. The survival rate specific to prostate cancer was 89% for men in the prostatectomy and radiation therapy group, compared to 74% among men who had radiation therapy and ADT.
The adjusted rates of overall survival were also better for men who had prostatectomies and radiation. There was a 64% survival rate for men in this group, compared to 48% for men who had radiation therapy and ADT.
The authors noted that in theory, the benefits of using radical prostatectomy as a primary treatment for men with locally or regionally advanced prostate cancer include reducing the tumor volume, optimizing localized control of the disease, as well as providing more accurate disease staging and risk stratification following surgery.
However, the data also showed a tradeoff for the higher survival rates for men in the prostatectomy and radiation therapy group. These men had higher rates of erectile dysfunction (28% vs. 20%) and urinary incontinence (49%vs. 19%).
Cancer. 2018 Sep 25. doi: 10.1002/cncr.31726.