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Surgery, radiation combo improves prostate cancer survival

By Allen Cone
Surgery, radiation combo improves prostate cancer survival
A micrograph shows prostatic acinar adenocarcinoma, which is the most common form of prostate cancer. A study found the combination of surgical removal of the organ and radiation therapy increases survival. Photo by Nephron/Wikimedia Commons

Sept. 25 (UPI) -- Prostate cancer patients may live longer if treated with a combination of surgical removal of the organ and radiation therapy, according to a study.

Researchers examined the records of 13,856 men 65 and older who participated in the Medicare-SEER registry from 1992 to 2009 and were diagnosed with locally advanced prostate cancer, meaning it had not yet metastasized to other body parts. Their findings were published Tuesday in the journal Cancer.

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"There's a lot of debate about whether to remove the whole prostate and follow up with radiation therapy. Or, as a second option, to spare the prostate and treat it using radiation therapy plus hormone-blocking therapy," Dr. Grace Lu-Yao, associate director of population science at the Sidney Kimmel Cancer Center-Jefferson Health in Philadelphia, said in a press release. "Our study suggests that removing the prostate followed by adjuvant radiotherapy is associated with greater overall survival in men with prostate cancer."

But both methods have risks and side effects, researchers say.

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Prostate removal, or prostatectomy, includes a higher chance of developing incontinence and erectile dysfunction. Radiation treatment and hormone therapy also have risks but they are typically less common and thought to have a lower impact on quality of life, Lu-yao said.

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"Prostatectomy is an unpopular treatment," Lu-Yao said. "Our study showed that only 6 percent of men with high-risk cancer were treated with it."

In addition, some men may not be fit enough for the surgery.

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The researchers broke down patients treated with prostatectomy plus adjuvant radiation as one group, and compared them to those treated with radiation therapy plus hormone-blocking therapy.

Ten years later, 89 percent of the prostate removal plus radiation group was still alive, compared with 74 percent survival in the group that received only radiation plus hormone therapy. One third of the deaths were secondary to prostate cancer.

"The proportion of men undergoing prostatectomy plus radiation therapy decreased significantly over time and there were trade-offs for the survival advantages," Lu-Yao said.

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Men who received the combination of surgery and radiotherapy had higher rates of erectile dysfunction -- 28 percent vs. 20 percent -- and higher rates of urinary incontinence -- 49 percent vs. 19 percent.

Only 29 percent of patients received the recommended combination therapies and 20 percent were not getting any treatment six months after their diagnosis, according to the research.

"Two modes of treatment are recommended by both United States and European guidelines for cancer treatment," Lu-Yao said. "Our data can't tell us the reason for this deviation from guidelines and further studies are needed."

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The study shows differences between "what happens in the real world, rather than the carefully controlled context of a clinical trial," he said.

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