Prostatectomy versus definitive radiation for localized prostate cancer: revisiting the debate at a tertiary cancer...

Surgery and radiotherapy are the main treatments for localized prostate cancer. Although many retrospective studies have compared their efficacy, evidence from the Middle East and North Africa (MENA) region is limited. This study reports real-world outcomes of patients treated with radical prostatectomy versus definitive radiotherapy at a tertiary cancer center in Jordan.

We conducted a retrospective cohort study of patients treated between June 2006 and June 2019. Patient demographics, disease characteristics, and treatment details were extracted from electronic medical records. Primary endpoints were cancer-specific survival (CSS) and overall survival (OS); secondary endpoints included metastasis-free survival (MFS) and biochemical relapse-free survival (BRFS). Survival outcomes and group differences were evaluated with the log-rank test.

Among 317 patients, median age was 68 years and median PSA 12.98 ng/mL. High-risk disease predominated (62.5%), followed by intermediate (32.8%) and low-risk (4.7%). Eighty-nine patients underwent radical prostatectomy and 228 received radiotherapy with androgen deprivation therapy (ADT). Five-year CSS and OS were excellent and similar between surgery and radiotherapy (CSS: 98.7% vs. 96.7%; OS: 90% vs. 89.6%). MFS was comparable (94.9% vs. 94.2%), while BRFS was lower in the surgical group (59.8% vs. 90.5%, p < 0.001). Recurrence occurred in 44.9% of surgical versus 14% of radiotherapy patients, and prostate cancer-specific deaths were 4.4% and 4.3%, respectively.

This study shows that surgery and radiotherapy achieve excellent long-term survival for localized prostate cancer. Radiotherapy with ADT provides superior biochemical control, emphasizing the importance of individualized, multidisciplinary treatment planning.