Therapies for Localized Prostate Cancer

Houston Methodist Researchers Examine Two Therapeutic Strategies And Their Impact On Survival For Localized Prostate Cancer.

Radical prostatectomy (RP) and radiation therapy (RT) are the most widely used and gold standard therapeutic strategies for localized prostate cancer (PCa) — a malignancy that affects men’s quality of life and mortality.

Raj Satkunasivam, MD

Raj Satkunasivam, MD, Associate Professor of Urology, performed rigorous statistical analyses in a population-based study to examine the survival rates of patients with localized PCa receiving RP and RT. There are a limited number of randomized clinical trials comparing therapies for PCa. Clinical trials can sometimes span three to five years, during which newer therapies and therapeutic methodologies can emerge, that render the original therapeutic strategies obsolete. The lack of evidence on the relative effectiveness of RP and RT prompted this study. Satkunasivam obtained data on localized PCa cases from the Breast and Prostate Cancer Data Quality and Patterns of Care study which was supported by the Centers for Disease Control and Prevention (CDC). According to the CDC, about 70% of PCa patients diagnosed between 2016 and 2020 had localized PCa.

He found that intensity-modulated RT (IMRT) was associated with a 41 percent increased risk of all-cause mortality, but not PCa-specific mortality, when compared with only RP. Details of this original research study were published in the Canadian Urological Association. Satkunasivam and his team obtained data on 8,229 men diagnosed with localized PCa in 2004 from seven state cancer registries in hospitals, offices and radiation facilities. Out of these, 3686 patients were analyzed — of which 3,019 received RP and 667 received IMRT. Satkunasivam concluded that IMRT was associated with a statistically significant increased risk of all-cause mortality but not PCa-specific mortality, as compared to RP. The 41 percent increased risk of all-cause mortality could be because the RT patients have a greater comorbidity burden. Comorbidities may include cardiovascular disease, hypertension, diabetes, and pulmonary disease.

“The major strength of our study is its generalizability, as it represents a population-based cohort created from the CDC National Program of Cancer Registries, which seeks to include all diagnosed cancer patients, regardless of age or insurance status,” said Satkunasivam. “Our cohort reflects the diversity of patients with localized prostate cancer regarding comorbidity, age, race, insurance status, along with practice and provider characteristics. To guide patient selection in an environment of shared decision-making, ongoing follow up of observational cohorts and completed randomized controlled trials will be needed.”

Prostate cancer cell, colored scanning electron micrograph (SEM). of the surface of prostate cancer cells. Getty Images.

Kenan Celtik, Christopher J.D. Wallis, Mary Lo, Kelvin Lim, Joseph Lipscomb, Steven Fleming, Xiao-Cheng Wu, Roger T. Anderson, Trevor D. Thompson, Andrew Farach, Ann S. Hamilton, Brian J. Miles, and Raj Satkunasivam. Localized prostate cancer: An analysis of the Centers for Disease Control and Prevention Breast and Prostate Cancer Data Quality and Patterns of Care study (CDC PoC-BP). Can Urol Assoc J. 2022 Jul; 16(7): E391–E398. Published online 2022 Feb 28. doi: 10.5489/cuaj.7580 Funding for the study was provided by the Hamill Foundation. The Breast and Prostate Cancer Data Quality and Patterns of Care study was supported by the Centers for Disease Control and Prevention through cooperative agreements with the California Cancer Registry (Public Health Institute) (1-U01-DP000260), Emory University (1-U01-DP000258), Louisiana State University Health Sciences Center (1-U01-DP000253), Minnesota Cancer Surveillance System (Minnesota Department of Health) (1-U01-DP000259), Medical College of Wisconsin (1-U01-DP000261), University of Kentucky (1-U01-DP000251), and Wake Forest University (1-U01-DP000264).

Abanti Chattopadhyay, PhD

December 2023

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