Study Favours Radiotherapy Over Surgery For Prostate Cancer

Prostate cancer is a major health issue for men across the world, especially those aged over 50. Although the risk varies significantly with factors such as ethnicity, family history, age and so on, it is the most commonly diagnosed cancer in men, affecting one in eight at some point in their lifetimes.

For this reason, finding the right treatment for each patient is a high priority. Not every prostate cancer is the same and some treatments (such as hormonal therapy) can work effectively for some patients, but not others. This is why personalised care is particularly important.

However, at Radiotherapy Healthcare Group, we know that radiotherapy can be an effective treatment, potentially used alongside other treatments (such as surgery, chemotherapy or hormonal therapy) that also play a part in a cancer management programme.

A key question for many patients and their oncologists often arises when the decision to be made lies between using surgery and radiotherapy. Surgery can have a lot of lasting (and often permanent) side-effects, including some loss of urinary and sexual function, which means radiotherapy can be preferable from a quality of life perspective.

New Study Supports Radiotherapy Over Surgery

New research from the United States has indicated that in the case of high-risk prostate cancer, radiotherapy is a better option than surgery. The study, by experts at the University Hospitals Seidman Cancer Center in Cleveland, Ohio, was published in European Urology Oncology.

It stated that when faced with high-risk cancer (defined as having a greater than normal chance of metastasis, which is when it spreads to other parts of the body to become secondary cancer), radiotherapy was more effective in preventing this from happening.

The key finding was that a combination of radiotherapy and androgen deprivation therapy reduced distant metastases by 32 per cent more over an eight-year period than the surgical option of radical prostatectomy.

Speaking to Medscape Medical News, one of the study’s authors, Daniel Spratt MD, said: “While it’s not a head-to-head randomized trial between surgery and radiation plus ADT, it provides compelling comparative data suggesting that radiotherapy plus ADT may not just be equivalent.”

Instead, he added, the radiotherapy treatment “might be better when it comes to controlling disease and reducing treatment escalation.”

More Research Needed

Dr Spratt acknowledged that the study “moves the needle but does not end the debate”, which means further research is required. Nonetheless, it does suggest that the best available evidence at present points to the preference of radiotherapy over surgery in high-risk prostate cancers.

Because the findings are tentative, they will require peer review and there is some scepticism about the findings.

Medscape Research News also spoke to William Kelly, head of oncology at Thomas Jefferson University Hospital in Philadelphia, who said the question of whether radiotherapy for this kind of cancer was the best option has “still not been answered”.

Nonetheless, it is studies of this kind that can mark the first step in a new understanding of what can be achieved by radiotherapy. Indeed, if more research backs up the study from Cleveland, the next stage may involve examining whether some methods of delivering radiotherapy are better calibrated than others to maximise the benefits.

Another Shift Away From Prostate Surgery?

The new study is not the only recent development with the potential to swing medical opinion in favour of alternatives to prostate cancer surgery.

Last month, British charity Prostate Cancer UK criticised what it called ‘outdated’ recommendations for slow-developing prostate cancer by government regulatory body the National Institute for Health and Care Excellence (NICE), which it said were leading to around 5,000 unnecessary surgeries every year.

It argued that NICE had failed to update guidance despite the knowledge that many slow-growing prostate cancers take so long to become a serious health risk that they won’t impact the patients in their lifetimes, in which case any side-effects from surgery, such as incontinence and impotence, may be suffered without due cause.

The charity revealed that its campaign on the issue brought a rapid response from NICE, which has expedited a review of its guidance. The last update of the guidance was made in 2021.

Personalised Care Matters

Although this particular review could lead to a greater focus on monitoring rather than surgery instead of increasing the use of radiotherapy, it does go to show that as medical science advances (both in terms of diagnostics and treatments), guidance can be amended and surgery can become less favoured.

If, therefore, you have prostate cancer and are unhappy with the treatment given so far, we may be able to offer an alternative through a fresh, evidence-based and personalised approach that makes use of the very latest treatments and understanding of your condition.

Learn more about our advanced radiotherapy treatments for prostate cancer on the Radiotherapy Healthcare Group website.