Prostatectomy v radiotherapy: possible detrimental effect of hormonal manipulation in patients receiving radiotherapyBMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g2273 (Published 25 March 2014) Cite this as: BMJ 2014;348:g2273
- Christopher G Eden, urological surgeon1
Evidence that surgery is more effective than radiotherapy at prolonging life in men with prostate cancer has been growing since the 1997 seminal study of 59 876 men,1 through two studies of 471 691,2 3 to Sooriakumaran and colleagues’ current paper,4 which also tackles head-on the problem of confounding factors.
Critics claim that these studies are irrelevant because radiotherapy has improved since they were performed and that higher doses are now routinely used. However, the current study found that the year of treatment had no bearing on the differences between survival after radiotherapy or surgery, perhaps because surgical techniques have also improved during this time. Improvements include the use of extended pelvic lymphadenectomy in men with intermediate and high risk prostate cancer, which increased cancer specific survival of men in these risk groups seven years after surgery by 12.6% and 20.3%, respectively, in a randomised controlled trial.5
The difference in the effectiveness of radiotherapy and surgery may not lie just in their biological and physical effects. Specifically, evidence continues to grow regarding the detrimental effect on overall survival produced by the use of neoadjuvant or adjuvant hormonal manipulation in patients receiving radiotherapy.6
Cite this as: BMJ 2014;348:g2273
Competing interests: None declared.