MedicalResearch.com Interview with:
Anthony Victor D’Amico, MD, PhD
Professor and Chief,
Genitourinary Radiation Oncology
Harvard Medical School
MedicalResearch.com: What is the background for this study?
Response: This study investigated whether surgery followed by the use of adjuvant low dose radiation and short course hormonal therapy as compared to high dose radiation and hormonal therapy could provide an equivalent low risk of death from prostate cancer amongst men presenting with aggressive and not infrequently fatal Gleason score 9 or 10 prostate cancer.
It has been shown previously (https://jamanetwork.com/journals/jama/fullarticle/2673969) and validated in the current study that surgery alone in such cases leads to a more then 2.5-fold increase in the risk of death from prostate cancer as compared to high dose radiation and hormonal therapy.
MedicalResearch.com: What are the main findings?
Response: We found that these 2 treatment options would lead to equivalent prostate cancer death rates with 77% certainty using a plausibility index metric.
MedicalResearch.com: What should readers take away from your report?
Response: Since often in current clinical practice surgery alone is offered initially to men with Gleason score 9 or 10 prostate cancer and low dose radiation and hormonal therapy not employed until cancer recurrence in the form of a rising PSA, many of these men may be losing a chance for cure.
Therefore, the study provides evidence to support the use of low dose radiation and hormonal therapyfollowing surgery in such men who have indications (i.e. extraprostatic extension, seminal vesicle invasion or positive surgical margins) for low dose radiation; (positive pelvic lymph nodes) and/or for hormonal therapy.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Whether the low prostate cancer death rates observed in the current would be realized if low dose radiation and hormonal therapy were administered at the time of PSA recurrence as opposed to following surgery and before PSA recurrence remains unknown. Ongoing randomized trials addressing this question did not stratify men prior to randomization by Gleason score 9,10 versus 8 or less, so those studies will not be able to definitively answer the question.
This leaves the current study as the only available evidence to support surgery followed by the appropriate use of low dose radiation and hormonal therapy as a treatment option for men with Gleason 9 or 10 prostate cancer.
There are no disclosures for conflicts of interest associated by the publication of these study from the authors.
Tilki D, Chen M, Wu J, et al. Surgery vs Radiotherapy in the Management of Biopsy Gleason Score 9-10 Prostate Cancer and the Risk of Mortality. JAMA Oncol. Published online November 15, 2018. doi:10.1001/jamaoncol.2018.4836
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