Is It Time to Reevaluate Definitive Therapy in Prostate Cancer?

Extract

In this issue of the Journal, Hoffman et al. ( 1 ) explore one of the many unanswered questions confronting newly diagnosed prostate cancer patients: Which definitive treatment is superior—radical prostatectomy (RP) or external beam radiotherapy (EBRT)? The authors analyzed an observational cohort from the population-based Prostate Cancer Outcomes Study treated in the mid-1990s, and the resulting data suggested a survival benefit associated with RP over EBRT ( 1 ). A propensity score analysis was used to adjust for treatment selection bias in this cohort of men aged 55 to 74 years with clinically localized disease. In men with high-risk tumors (Gleason score ≥ 8 or prostate-specific antigen > 10), both overall and prostate cancer–specific mortality were statistically significantly lower in the group that received RP than the group that received EBRT. In men with low-risk tumors (Gleason score ≤ 6 and prostate-specific antigen ≤ 10), there was no difference in prostate cancer mortality and a modest but statistically significant difference in overall mortality. Notably, this analysis did not include intermediate-risk patients. It is also interesting to note that acceptance of active surveillance as a treatment option for most, if not all, patients with low-volume, low-risk disease is much greater now that it was when this study was initiated.