Patients with high-risk prostate cancer achieve the best outcomes with aggressive treatment. A large retrospective cohort study published in the Journal of the American Medical Association (JAMA) on March 6, 2018 helps to show a shift in thinking about what “aggressive” treatment actually looks like.
In the past, most urologists would recommend radical prostatectomy for patients with high risk prostate cancer as they felt most comfortable that this “aggressive treatment” would translate into higher cure rates. These patients would then be offered post-operative treatment based upon the pathologic findings after surgery.
The JAMA study looked at over 1800 patients treated in 12 medical centers between 2000 and 2013 and found that those diagnosed with aggressive prostate cancer with a Gleason score of 9 and 10 (the highest possible score, indicating the cancer is likely to spread quickly) had significantly better long-term survival and slower disease progression when treated with non-surgical option of external beam radiation and brachytherapy boost with hormonal blockade. Additionally, patients treated with external beam radiation to doses above 78Gy and hormonal therapy also had superior prostate cancer–specific mortality and distant metastasis outcomes compared to surgically treated patients.
I believe these findings are impactful since patients with high-risk prostate cancer are often funneled into treatments such as radical prostatectomy (surgical removal of the prostate gland) under the belief that it yields higher cure rates. This study reveals that patients can be treated as successfully or even with better outcomes with radiotherapy options along with systemic hormonal treatment.
Although many studies have shown increased doses of radiotherapy combined with hormonal therapy improve short term outcomes this study shows a difference in long term survival in high-risk prostate cancer patients.
Prostate cancer is one of the most common cancers among men, with approximately one in every nine men diagnosed with the disease during a lifetime. It is also one of the leading causes of cancer deaths, especially in high-risk prostate cancer patients, resulting in nearly 30,000 deaths each year.
Studies such as this are valuable to physicians who treat prostate cancer patients because they allow us to identify the high-risk patients who will likely benefit from an aggressive non-surgical treatment approach.
For questions about prostate cancer treatment options available at Ackerman Cancer Center, please contact me at perkinsMD@ackermancancer.com.