"Highrisk prostate cancer that which has continued to grow but not yet metastasized is commonly treated with combination therapies. Each method has pros and cons but there is little clarity whether one might be more effective than the other. For the first time researchers have shown that more patients live longer if treated with the combination of prostate removal plus radiation therapy. The research was published September th in the journal Cancer.  Theres a lot of debate about whether to remove the whole prostate and follow up with radiation therapy. Or as a second option to spare the prostate and treat it using radiation therapy plus hormoneblocking therapy said senior author Grace LuYao https_oncologyfacultyluyao.html PhD Associate Director of Population Science at the Sidney Kimmel Cancer Center  Jefferson Health http one of only eight NCIdesignated cancer centers nationwide with a prostate cancer program of excellence. Our study suggests that removing the prostate followed by adjuvant radiotherapy is associated with greater overall survival in men with prostate cancer. The risks of prostate removal or prostatectomy are well known and include higher chance of developing incontinence and erectile dysfunction. There are some risks associated with radiation treatment and hormone therapy but they are less common and are typically thought to have a lower impact on quality of life. Prostatectomy is an unpopular treatment said LuYao. Our study showed that only six percent of men with highrisk cancer were treated with it. Its not just the risk of side effects.For some men especially those who are not fit enough for the surgery prostatectomy is not an option. However this may be an option for some patients to reconsider. In the largest populationbased retrospective study to date Dr. LuYao and colleagues examined the records of  men in the MedicareSEER registry diagnosed with locally advanced prostate cancer  cancer growth that had not yet metastasized to distant sites in the body. Dr. LuYao and colleagues looked at the patients who were treated either with prostatectomy plus adjuvant radiation as one group and compared them to another group who were treated with radiation therapy plus hormoneblocking therapy. They matched the comparison groups by age race and comorbidity to control for factors that may influence patient outcomes and analyzed which group did better  to  years after their procedures.  They found that  years after treatment  percent of the prostate removal plus radiation group was still alive. That compared with the  percent survival at ten years in the group that received only radiation plus hormone therapy amounting to a  percent survival advantage in the group that was treated with prostate removal.  For highrisk prostate patients we started the use of aggressive radiation therapy after surgery  years ago said Adam Dicker httpshospitals.jefferson.edufindadoctorddickeradamp.html 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 tradeoffs for the survival advantages said Dr. LuYao. Men who received the combination of surgery and radiotherapy had higher rates of erectile dysfunction  percent vs  percent and higher rates of urinary incontinence  percent vs  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  percent of patients received the recommended combination therapies and as many as  percent are not getting any treatment six months after their diagnosis said Dr. LuYao. Our data cant 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. LuYao. Our data is revealing the realworld practice as well as some of the advantages and disadvantages of those medical preferences.  This important study demonstrates that many men with highrisk prostate cancer derive a survival advantage through a multimodality 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 httpshospitals.jefferson.edufindadoctorggomellaleonard.html Chair of the Department of Urology at Jefferson Philadelphia University  Thomas Jefferson University who was not involved in this research.  The study was funded by the New Jersey Health Foundation the National Cancer Institute P CA and CA and the Rutgers Cancer Institute of New Jersey Biometrics Shared Resource. A complete list of potential conflict interest disclosures can be found in the manuscript. Article reference Thomas L. Jang Neal Patel Izak Faiena Kushan Radadia Dirk F. Moore Sammy E. Elsamra Eric A. Singer Mark N. Stein James A. Eastham Peter T. Scardino Yong Lin Isaac Y. Kim Grace L. LuYao Comparative effectiveness of radical prostatectomy with adjuvant radiotherapy versus radiotherapy plus androgen deprivation therapy for men with advanced prostate cancer Cancer DOI .cncr. . Media Contact Edyta Zielinska edyta.zielinskajefferson.edu mailtoedyta.zielinskajefferson.edu ."