Radiation Vs. Surgery for Prostate Cancer

Prostate cancer treated with radiotherapy offers long term survival rates

/ Author:  / Reviewed by: Robert Carlson, M.D

(RxWiki News) Prostate cancer treatments can include a variety of approaches. Surgery can remove the diseased prostate, while radiation therapy can be used to kill cancer cells.

But what’s the long-term effectiveness of radiotherapy for treating prostate cancer? To find out, researchers tracked 25 years of data.

Nearly three-quarters of prostate cancer patients were still alive 25 years after being treated with radiation therapy, according to a newly published study.

These survival rates are comparable to those achieved by surgically removing the prostate – a procedure called a prostatectomy.

"If you’ve had prostate cancer, 15 years of follow up is recommended."

Frank Critz, MD, founder and medical director at Radiotherapy Clinics of Georgia (RCOG), and colleagues conducted the study which reviewed 30 years’ worth of data. It’s the longest study of its kind looking at the long-term effects of prostate cancer radiotherapy.

“This study, the longest after irradiation of prostate cancer, confirms using the surgical PSA definition (PSA <0.2 ng/ml) that results from this program are equal to that of radical prostatectomy, thus giving men a choice of treatment, and after 15 year follow up if the PSA is <0.2, late recurrence will be rare,” Dr. Critz said in a news release announcing the study results.

Prostate specific antigen (PSA) levels in the blood are used to predict the presence of prostate cancer.

"I commend Dr. Critz and co-workers for raising the bar and stating that a nadir PSA of <0.2 ng/ml is the standard," prostate cancer specialist E. David Crawford, MD, told dailyRx News. 

For this study, the team followed the outcomes of nearly 4,000 men who been treated for prostate cancer between 1984 and 2000.

A total of 3,546 men had undergone two types of radiotherapy. The treatment began with implanting radioactive beads (I-125 implant), which was then followed by radiation that was given externally.

Technology changed over the course of the study. The first group of men studied received retropubic implants placed through the abdomen – a technique which is no longer used. With technology updates, the newer transperineal template/ultrasound-guided approach was used in 2,875 men. This approach involves placing the implants though the skin between the scrotum and the anus.

This study looked at disease-free survival (DFS) of men at 10-, 15-, 20- and 25-year intervals. Disease-free survival is defined as being alive without any evidence of disease.

Here’s what the study found:

  • Among men who had received radiation-only therapy, the overall DFS was 75 percent at 10 years, and 73 percent 15, 20 and 25 years after treatment.
  • Men studied were an average of 65 years of age at the time of treatment.
  • Men who received the latest treatment technology had a 15-year DFS of 79 percent.
  • Among men who had prostatectomies between 1984 and 2000, the 10-year DFS was 75 percent and the 15-year DFS was 73 percent.

“Although 10-year DFS are a reasonable measure, this study suggests that at least 15 years of follow-up are needed to fully evaluate the effect of any PC therapy,” the authors concluded.

Furthermore, for men with PSA levels of <0.2 ng/ml, recurrence of prostate cancer after 15 years is rare, the authors wrote.

"This study should be cited when discussing long-term results of therapy with men," said Dr. Crawford, who is professor of surgery, urology, and radiation oncology, and head of the Section of Urologic Oncology at the University of Colorado Health Sciences Center in Denver.

This study was published in the March issue of The Journal of Urology. No financials were provided.

RCOG is the largest community-based prostate program in the United States. It is an affiliate of Vantage Oncology of Atlanta, Georgia.

Reviewed by: 
Review Date: 
February 27, 2013
Last Updated:
March 2, 2013