High-risk PCa: Urological or radiation oncological approach

In the multidisciplinary Thematic Session 18, the urological and radiation oncological approaches to high-risk prostate cancer were discussed. The chairman of the session, Prof. Christian Stief (Munich, DE), introduced the debate by stating that the audience would hear “not necessarily opposing but merely different views on how to treat patients.”

Profs. Francesco Montorsi (Milan, IT) and Gert De Meerleer (Ghent, BE) defended surgical treatment and radiation therapy in high-risk prostate cancer, respectively. Montorsi started his presentation stating his conclusion: “We finally have the answer to the question of whether surgery or radiation therapy is better.”

Citing the recently published Sooriakumaran et al. study, Montorsi showed that radical prostatectomy improves overall survival, compared to radiation therapy. He added that extended lymph node dissection should be part of the procedure and adjuvant or salvage radiation therapy is an important additional treatment option for some patients.

In response, De Meerleer presented the oncological view. “Let me start by giving you my conflict of interest disclosure: I am a radiation oncologist,” he jokingly started. He acknowledged that this had been a bad year for radiation therapy, due in large part to the Sooriakumaran study.

He went on to say that the title of the study is misleading because the studied comparison is not really between surgery and radiation therapy. Since more than 60% of patients who underwent radical prostatectomy were also treated with radiation therapy, the actual comparison is between radiation therapy alone or in combination with surgery. De Meerleer urged for a change in terminology to prevent this type of misrepresentation.

Like Montorsi, De Meerleer stressed that lymph node dissection is important in this patient group. “I was taught that patients with enlarged lymph nodes are dead, but we should stop treating these patients as untreatable. The results after lymph node dissection are promising,” he said.

The most important message from this session was a truly multidisciplinary one. Both speakers concluded that rather than continuously opposing each other, urologists and oncologists should work together to treat patients with high-risk prostate cancer.