EBRT with Brachytherapy Matches Surgery for Prostate Ca - Worse survival without boost in high-risk patients
Men with high-risk localized prostate cancer had similar survival with surgery or with the combination of external beam radiotherapy (EBRT) plus brachytherapy, according to a retrospective review of more than 40,000 cases.
After adjustment for lymph node status, Gleason score, clinical T stage, and other factors, the resulting survival hazard for radical prostatectomy versus combined radiation therapy did not achieve statistical significance and numerically favored the nonsurgical approach (HR 1.17, 95% CI 0.88-1.55). The addition of androgen deprivation therapy (ADT) to radiotherapy did not improve survival as compared with EBRT plus brachytherapy .without ADT.
The prostate is a male sex gland responsible for producing fluid that forms semen. It is located below the bladder, in front of the rectum and surrounds the urethra. The prostate is divided into three zones enclosed by a capsule. The prostate capsule separates the prostate from the rest of the body.
The prostate gland typically enlarges as men grow older. This growth of the gland is called benign prostatic hyperplasia (BPH) and most often occurs in the transition zone of the prostate, which surrounds the urethra. Prostate growth in this area may block the bladder or urethra and prevent the flow of urine. Men may experience frequent or painful urination; blood in the urine or semen; and stiffness or pain in the lower back. These symptoms may be caused by BPH or they may be signs of cancer.
Prostate cancer occurs when the cells in the prostate gland grow out of control. When cells grow out of control, they initially spread within the prostate and then grow through the capsule that covers the prostate into neighboring organs, or break away and spread through the bloodstream and lymphatic system to other parts of the body. Prostate cancer can be relatively harmless or extremely aggressive. Some prostate cancers are slow growing, causing few clinical symptoms. In these cases, a patient will often die with prostate cancer rather than from prostate cancer. Aggressive cancers spread rapidly to the lymph nodes, other organs and especially, bone.
The suspicion of prostate cancer usually arises from an elevated prostate-specific antigen (PSA) blood level test and/or a digital rectal exam (DRE). PSA is a protein that is normally secreted and disposed of by the prostate gland. High PSA levels sometimes indicate the presence of cancer; however, more tests are needed to confirm this suspicion. During a DRE, a physician inserts a gloved finger into the rectum to assess the texture and size of the prostate.
If the results from a PSA blood test and/or a DRE suggest that prostate cancer may be present, this suspicion needs to be confirmed by a biopsy. Prostate cancer is diagnosed by performing one or more biopsies of the prostate gland. The biopsy will determine whether a patient has BPH, cancer or another medical problem. During a biopsy, a needle is used to remove several small pieces of prostate tissue through the rectum. These tissue samples are then examined under the microscope to determine whether cancer cells are present.
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