Recent reviews, reports and research about relative effectiveness of different treatments for prostate cancer

Prostate cancer-related mortality after EBRT higher than after radical prostatectomy. In an article in the 9 October 2014 Renal&Urology News, Jody A Charnow summarises a study of mortality rates for 13,803 men who undertook either radical prostatectomy, EBRT (external beam radiation therapy) or brachytherapy. The study was led by Andrew J Stephenson MD of Cleveland Clinic. Charnow states that the study indicates that: “External beam radiation therapy is associated with greater 10-year prostate cancer-specific mortality (PCSM) than radical prostatectomy across a range of nomogram-predicted risks of biochemical recurrence.” and “The investigators found no significant difference in PCSM risk between brachytherapy and radical prostatectomy, although they acknowledged that patient selection factors and lack of statistical power limited this analysis.” The Charnow article can be read here or here: http://tinyurl.com/kwap7yr

Comparative effectiveness of radical prostatectomy and radiotherapy in prostate cancer.
In the April 2013 edition of The Walnut we reported a brief press release on a study undertaken in Sweden by Prasanna Sooriakumaran et al. This was an observational study reporting survival outcomes for based on data for 34,515 men who had been treated via surgery or radiotherapy. The details for the study can be viewed here or here: http://tinyurl.com/l4sqlge The authors conclude that: “This large observational study with follow-up to 15 years suggests that for most men with non- metastatic prostate cancer, surgery leads to better survival than does radiotherapy. Younger men and those with less comorbidity who have intermediate or high risk localised prostate cancer might have a greater benefit from surgery.”

Surgery superior to radiotherapy in men with localised prostate cancer. In a press release of the European Association of Urology's 28th Annual UAE Congress dated 11 March 2013, a summary is provided of the content of a paper by Dr. Sooriakumaran et al reporting the results of a large scale observational study. The press release includes this content: "Surgery offers better survival benefit for men with localised prostate cancer, according to a large observational study, conducted by a group of researchers in Sweden and the Netherlands. The study won the second prize for best abstract in oncology at the 28th Annual EAU Congress which will open in Milan this Friday, 15 March. 'The current gold standard management of localised prostate cancer is radical therapy, either as surgery or radiation therapy. This study suggests that surgery is likely superior to radiation for the majority of men who have localized prostate cancer, especially the younger age group and those with no or few comorbidities,' said Dr. Prasanna Sooriakumaran, lead study author, of the Karolinska University Hospital in Stockholm. In their study, Sooriakumaran and colleagues compared the oncologic effectiveness of radical prostatectomy and radiotherapy in prostate cancer, and analysed the mortality outcomes in 34,515 patients treated with up to 15 years follow-up." The press release can be downloaded from here: http://tinyurl.com/cwpvzgh

Prostate Cancer Results Study Group (PCRSG) update. The PCRSG which is led by Dr Peter Grimm of the Prostate Cancer Treatment Center in Seattle is conducting an ongoing "meta-analysis" of published research studies that report on the effectiveness of different treatments for prostate cancer. A 2009 report on the Center’s web site here provides a very readable description of the study. Dr Grimm has released presentations progressively showing the results of the ongoing analysis. The most recent presentation is dated 15 January 2013. This is entitled Comparing Treatment Results of Prostate Cancer - Prostate Cancer Results Study Group. It can be downloaded as a 6 MB file from our site here. If you would like to be added to the distribution list for future releases of the reports of the PCRSG, the Centre’s contact details are provided in that presentation. A shorter 3.6 MB version containing 17 slides and with some explanatory content has been prepared by our Group and can be downloaded from our site here.

Comparison of side effects for treating prostate cancer via radical prostatectomy and IMRT (Intensity-Modulated Radiotherapy). Author: Fran Lowry. Medscape Urology News, 30 January 2013 Extract from the article: Men (aged 55 to 74 at treatment - Ed.) with localized prostate cancer who elect to have prostatectomy or radiotherapy will experience problems with urinary, bowel, and sexual function in the long term, according to a new study published today in the New England Journal of Medicine... Data from the Prostate Cancer Outcomes Study (PCOS) show that in the short term, men who have had surgery will have more urinary incontinence and sexual dysfunction, and those who have had radiotherapy will have more bowel dysfunction, but by 15 years, dysfunction in all domains is not significantly different..."Whatever the reason, it could be aging, it could be the treatment, it could be secondary treatments, but in the long run, there are not a lot of differences between the 2 primary treatments for localized disease, whether they are surgery or radiation," senior author David F. Penson MD, told Medscape Medical News. The results from PCOS should give men with localized prostate cancer pause before they choose a treatment, Dr. Penson said. Web link: http://www.medscape.com/viewarticle/778498 (See abstract for the Penson study here: http://tinyurl.com/axqvyrc Note that the men in this study were aged between 55 and 74 at treatment and so would have been aged 70 to 89 at the 15-year follow-up date.)

Podcast entitled
Men’s Health: Interesting new research into prostate disease and prostate cancer. ABC Radio National Health Report podcast 14 March 2011 presented by Dr Norman Swan. The radio broadcast can be listened to or downloaded from here. A copy of the transcript is here as a 140 KB PDF file. Of the people interviewed two are of particular interest: Dr Tom Pickles being interviewed about the results of an ongoing study of reports on the efficacy of different types of treatments for prostate cancer, and Prof. Pamela Russell being interviewed about work being undertaken on gene therapy for late stage prostate cancer. The ongoing study that Dr Pickles refers to in the interview is one lead by Dr Peter Grimm of the Prostate Cancer Treatment Center in Seattle under the auspices of the ‘Prostate Cancer Results Study Group’ (PCRSG).  This study is described in an entry above on this web page, together with links to the PCRSG's report slides.