The effect of surgery and radiotherapy on oncological outcomes in high-risk prostate cancer

INTRODUCTION: The best treatment approach is still a matter of debate in high-risk prostate cancer patients. Recommended treatment approaches are surgery (radical retropubic prostatectomy) or radiotherapy (RT) + androgendeprivationtherapy (ADT). In our study, we compared the oncological outcomes of surgery and radiotherapy in high-risk prostate cancer.
METHODS: Fifty patients who were treated with high-risk prostate cancer in our clinic were retrospectively studied between January 2008 and June 2015. Twenty patients with open radical retropubic prostatectomy (RRP) were included in the surgical group and 30 patients with RT + ADT therapy were included in the radiotherapy group. Groups were evaluated in terms of biochemical recurrence (BCN), biochemical recurrence-free survival (BFSR), cancer-specific survival (CFS), and overall survival (GFS).
RESULTS: Mean age of the patients was calculated 65.9 (range 51-83), mean baseline PSA levels were 24.2 (range 1-94.9), and mean follow-up was 50.24 months (range 6-84). The follow-up period was 55.7 months in the surgical group and 46.6 months in the RT group. Patient age, initial PSA level and clinical stage were found higher in RT group but no significant statistical difference was found. According to biopsy and prostatectomy pathologies in the surgical group; 4 (20%) patients were upgrading and 10 (50%) patients were downstaging. Four patients (20%) which observed Gleason pattern 5 was detected biochemical recurrence. No pattern 5 was detected in the biopsy of any patient in the radiotherapy group.
DISCUSSION AND CONCLUSION: Similar to many studies in the literature, we found that patients treated with RT + ADT in high risk prostate cancer had beter oncologic outcomes than those with RRP.

Yüksek riskli prostat kanserinde cerrahi ve radyoterapinin onkolojik sonuçlara etkisi

GÝRÝÞ ve AMAÇ: Yüksek riskli prostat kanseri hastalarýnda en iyi tedavi yaklaþýmýnýn ne olduðu, halen tartýþmaya açýk bir konudur. Önerilen tedavi yaklaþýmlarý; cerrahi (radikal retropubik prostatektomi) veya radyoterapi (RT) + androjen deprivasyon tedavisi (ADT) dir. Çalýþmamýzda yüksek riskli prostat kanserinde cerrahi ve radyoterapinin onkolojik sonuçlarýný karþýlaþtýrdýk.

YÖNTEM ve GEREÇLER: Ocak 2008-Haziran 2015 arasýnda kliniðimizde yüksek riskli prostat kanseri tanýsýyla tedavi edilen 50 hasta retrospektif olarak incelendi. Açýk radikal retropubik prostatektomi (RRP) yapýlan 20 hasta cerrahi grubuna, RT+ADT tedavisi verilen 30 hasta radyoterapi grubuna dahil edildi. Gruplar tedavi sonrasý takipte, biyokimyasal nüks (BKN), biyokimyasal nükssüz sað kalým (BFSK),kanser spesifik sað kalým (KSK) ve genel sað kalým (GSK) açýsýndan incelendi.
BULGULAR: Hastalarýn ortalama yaþý 65.9 (51- 83 aralýðýnda), ortalama baþlangýç PSA seviyeleri 24.2 (1- 94.9 aralýðýnda) ve ortalama takip süresi 50.24 ay (6- 104 aralýðýnda)olarak hesaplandý. Takip süresi cerrahi grupta 55.7 ay, RT grubunda 46.6 ay idi. Hasta yaþý, baþlangýç PSA deðeri ve klinik evre RT grubunda daha yüksek saptandý ancak anlamlý bir istatistiksel fark bulunmadý. Cerrahi grupta biyopsi ve prostatektomi patolojilerine göre; 4 (% 20) hastada upgrading, 10 (% 50) hastada downstaging gözlendi. Gleason patern 5 gözlenen 4 (% 20) hastanýn hepsinde BKN saptandý.Radyoterapi grubunda ise hiçbir hastanýn biyopsisinde patern 5 saptanmadý.
TARTIÞMA ve SONUÇ: Literatürdeki pek çok çalýþmaya benzer þekilde, bizim çalýþmamýzda da yüksek riskli prostat kanserinde RT+ADT uygulanan hastalarýn RRP uygulananlara göre, daha iyi onkolojik sonuçlar içerdiðini saptadýk.