In a Swedish retrospective study they compared 34 515 men primarily treated for prostate cancer with surgery (n=21 533) or radiotherapy (n=12 982). Patients were categorised by risk group (low, intermediate, high, and metastatic), age, and Charlson comorbidity score.
However, the patients were not chosen randomly, as would have been the case in a randomized clinical trial. The data reveals certain preferences. Thus, more men in the advanced stage and with unfavorable histology decided for radiation therapy. PSA levels were also higher than patients who preferred radical prostatectomy.
These factors can explain a higher rate of recurrences and deaths after radiotherapy. In addition, patients who received radiation therapy were slightly older and had higher comorbidity. This, too, could have worsened the survival. Finally, there were factors such as low education, a lower socioeconomic status, and a higher proportion of non-married people whose impact is difficult to estimate in the radiotherapy group.
Finally, only 339 patients died of prostate cancer and 1,064 other causes (after a median follow-up period of 5.37 years) in the radical prostatectomy group.
After radiation therapy, 697 died of prostate cancer and 1,127 patients on other reasons during the same period. This is significantly more when one considers that almost twice as many patients voted for surgery.
This large observational study with follow-up to 15 years suggests that for most men with non-metastatic prostate cancer, surgery leads to better survival than does radiotherapy. Younger men and those with less comorbidity who have intermediate or high risk localised prostate cancer might have a greater benefit from surgery.