Evaluation of response to prostate cancer treatment in patients with radiotherapy or surgery

Prostate cancer is the most common non-cutaneous cancer in men. Nowadays by the progress of diagnosis and screening methods, detection of disease becomes possible in early stages. In this study, we aimed to compare efficacy of treatment methods using overall survival (OS) and biochemical recurrence free survival (BRFS) rates by scanning available data of patients who were treated with definitive radiotherapy (RT) or radical prostatectomy (RP) with diagnosis of prostate cancer between 2005-2015 at the Hospital of Atatürk University Faculty of Medicine. There were totally 128 patients in both arms. Patients were categorized according to D'Amico risk classification as low, intermediate and high. 82 patients were treated with RP and 46 patients were treated with definitive RT. RT +/- hormonal therapy (HT) had been applied in RT arm as radical retropubic prostatectomy +/- pelvic lymph node dissection (PLND) in RP arm. Mean follow-up time was 45.8 months as average age at diagnosis was 64.6±7 years in RP arm, it was 69.9± 6.7 years in RT arm. Biochemical recurrence was not detected in 10 years follow-up duration of the patients in low-risk group. While there was no difference between the treatment arms in terms of biochemical recurrence in the intermediate risk group patients, it was detected that RT arm was significant better statistically in the high risk group (p=0,04). According to treatment arms, OS rates were found as % 94.8 for RP and % 86.3 for RT (p=0,019). According to treatment types in terms of risk groups, survival rates of low, intermediate and high risk group in RP arm were % 97.1, % 93.8, % 92.3, in RT arm were % 81.8, % 92.9, % 90.5, respectively, as OS was analysed (p>0,05). According to the treatment arms, BRFS rates were found as % 97 for RP and % 90.9 for RT (p>0,05). According to the treatment types in terms of risk groups, survival rates of intermediate and high risk group in RP arm were % 92.3 and %95.2 , in RT arm were % 79.6, % 81.6, respectively, as BRFS was analysed (p>0,05). It was seen that definitive RT was more succesfull in high risk group patients as biochemical recurrence rate was examined according to risk groups. RP was found to be superior in terms of OS rate just according to the treatment types. As BRFS and OS rates were examined, there was no significant difference between the two arms in terms of risk groups. Disadvantages in the RT arm were high age-average of patients, high rates of comorbid disease, nonhomogenious distribution of the groups and inability to achieve more effective RT doses with 3 dimensional conformal RT (3D-CRT). As a result; longer follow-up comparative studies that will contribute to multidisciplinary approach is needed as RT is more effective with the therapeutic techniques such as intensity modulated RT (IMRT).