They found that 10 years after treatment, 89 percent of the prostate removal plus radiation group was still alive. That compared with the 74 percent survival at ten years in the group that received only radiation plus hormone therapy, amounting to a 15 percent survival advantage in the group that was treated with prostate removal.

"For high-risk prostate patients we started the use of aggressive radiation therapy after surgery 20 years ago," said Adam Dicker, Senior Vice President and Chair of the Department of Enterprise Radiation Oncology at Jefferson Health, who was not involved in the study. "We recognized that it may have curative potential."


"However, the proportion of men undergoing prostatectomy plus radiation therapy decreased significantly over time and there were trade-offs for the survival advantages," said Dr. Lu-Yao. Men who received the combination of surgery and radiotherapy had higher rates of erectile dysfunction (28 percent vs 20 percent) and higher rates of urinary incontinence (49 percent vs 19 percent).

Another interesting finding from the research was that slightly more than half of men diagnosed with the disease did not receive combination therapies for their prostate cancer. "Two modes of treatment are recommended by both United States and European guidelines for cancer treatment. It was surprising to see only 29 percent of patients received the recommended combination therapies, and as many as 20 percent are not getting any treatment six months after their diagnosis," said Dr. Lu-Yao. "Our data can't tell us the reason for this deviation from guidelines and further studies are needed."

"One of the strengths of retrospective studies of patient data is that it reveals what happens in the real world, rather than the carefully controlled context of a clinical trial," said Dr. Lu-Yao. "Our data is revealing the real-world practice as well as some of the advantages and disadvantages of those medical preferences."

"This important study demonstrates that many men with high-risk prostate cancer derive a survival advantage through a multi-modality approach to their disease. Several large clinical trials are nearing completion that should validate these retrospective findings of the benefits of primary radical prostatectomy followed by additional therapies such as adjuvant radiation," said Leonard Gomella, Chair of the Department of Urology at Jefferson (Philadelphia University + Thomas Jefferson University), who was not involved in this research.

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