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| |  Study Finds External Beam Radiation Less Effective in Prostate Cancer Survival Than Brachytherapy or Surgery: Presented at PCS By Ed Susman KISSIMMEE, FL -- February 27, 2007 -- Outcomes data show that survival after definitive therapy for prostate cancer appears to be better for brachytherapy or radical prostatectomy than for external beam radiation, researchers reported here at the 3rd Prostate Cancer Symposium (PCS). Despite the findings, the researchers were quick to point out that all 3 of the procedures had cure rates that were greater than 90% -- and the absolute difference in outcomes represents about a 2% difference in chance of survival. "These findings indicate that the 3 major forms of treatment for early-stage prostate cancer are not necessarily equivalent in terms of overall survival," said Jay Ciezki, MD, staff physician, department of radiation oncology, Cleveland Clinic, Cleveland, Ohio, United States. These findings persisted after the researchers controlled for potential confounding factors, such as age, other illnesses, and smoking history, Dr. Ciezki said in an oral presentation February 24th. Dr. Ciezki and colleagues conducted an analysis of 5-year overall survival in 2,345 men treated at the Cleveland Clinic between 1996 and 2003 for low- or intermediate-risk prostate cancer. Of this cohort, 665 men were treated with brachytherapy, 615 men were treated with external beam radiation therapy, and 1,065 with radical prostatectomy. The researchers controlled for factors the patient's general health (Charlson score), including other illnesses, age, smoking status, cardiovascular health, and alcohol use, among others. After 5 years, 93.8% of the men who received external beam radiation therapy were alive, compared with 95.7% of those who received brachytherapy and 97.7% of those who had radical prostatectomy. After controlling for confounding factors, brachytherapy and surgery were found to be equally effective, while external beam radiotherapy remained less effective. Smoking, greater Charlson score, and age were also independently associated with reduced overall survival. "It is unlikely that this study will change clinical practice because, basically, all these treatments produce very good results," commented Deborah Kuban, MD, professor of radiation oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, United States "We are fortunate that we can offer patients 3 options that are each so successful." "Even though there may be statistical differences in outcomes, this still is not a randomised trial and without randomisation, it is difficult to account for all the variables," Dr. Kuban said. In addition, the type of radiation therapy being performed in 2003 probably differed to some extent from that done in 1996, she said. Similarly, small differences in brachytherapy and even changes in surgery could confound the results, she said. "There have been a lot of changes over 7 years," she added. There was no industry funding of the study. The meeting is cosponsored by the American Society of Clinical Oncology, the American Society for Therapeutic Radiology and Oncology and the Society of Urologic Oncology.
[Presentation title: A Comparison of Overall Survival between Patients with Low and Intermediate-Risk Prostate Cancer Treated with Brachytherapy, External Beam Radiotherapy, or Radical Prostatectomy. Abstract 293]
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