Surgical methods outperform radiation therapy in prostate cancer

By Sally Robertson, B.Sc.Jan 9 2013

A surgical method for treating localized prostate cancer may be a better option for patients than radiation therapy (RT), show findings from a cost-effectiveness analysis.

In general, surgery was preferred over RT for men at low risk for disease, whereas combined external-beam radiation therapy and brachytherapy (EBRT+BT) was favorable for men at high risk, report Matthew Cooperberg (UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, USA) and team.

"Across the risk spectrum, RT was consistently more expensive [than surgical methods]," they add.

The team used a Markov model to follow hypothetical men with low-, intermediate-, and high-risk prostate cancer over their lifetime and after primary treatment. They found that there were significant, but modest, differences in quality-adjusted life years (QALYs) across the treatment options.

Among low-risk patients, those who received three dimensional conformal RT (3DCRT) had the fewest QALYs, compared with those who received BT, EBRT+BT, and intensity-modulated RT.

In contrast, EBRT+BT was the most effective method for intermediate- and high-risk patients.

However, there were no significant differences in QALYs among low-, intermediate-, or high-risk patients across the surgical methods used and, with the exception of EBRT+BT for high-risk disease, surgical alternatives were significantly more effective than RT methods overall.

Furthermore, lifetime costs were statistically and clinically similar across surgical methods among the different risk groups, whereas lifetime costs for RT varied substantially by treatment method across risk strata.

"We believe that through incorporation of both QALYs [quality-adjusted life years] and costs, consistent risk-stratification, inclusion of multiple methods within surgery and RT, and use of lifetime horizon, the present analysis is the most comprehensive economic analysis yet undertaken for this disease," the researchers say.

The findings may inform future policy discussions about strategies to improve efficiency and reduce variation in localized prostate cancer care, concludes the team in BJU International.

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