Surgery vs. Radiation Therapy for High-Risk Localized Prostate Cancer

Patients with high-risk but localized prostate cancer usually are given the option of surgery or radiation therapy, but randomized trials to evaluate these outcomes are lacking for this patient population. In an observational study, researchers used the U.S. Surveillance, Epidemiology, and End Results (SEER) database to examine outcomes with radical prostatectomy and external-beam radiation in 24,000 patients with localized high-risk or very-high-risk prostate cancer (according to Johns Hopkins classification). Propensity-score matching was used to compare cohorts of surgical and radiation-therapy patients who were similar in age, Gleason score, clinical stage, and prostate-specific antigen level.

Prostate cancer–specific mortality at 5 years was significantly lower with surgery than with external-beam radiation therapy (2.3% vs. 4.1%; P<0.001). The absolute differences were greater in the subgroup with very-high-risk cancers (3.5% vs. 6.0%; P<0.001) and smaller in the subgroup with “only” high-risk cancers (0.7% vs. 1.2%; P=0.22).