Radical treatment can double the life expectancy of men with advanced prostate cancer, according to a controversial study that overturns the current expert view.
Surgery to remove the prostate gland and radiotherapy are normally reserved for patients whose disease has not yet started to spread.
The thinking is that such radical therapy aimed at the prostate is pointless because “the horse has bolted”.
Instead, men with advanced prostate cancer are usually offered androgen deprivation therapy (ADT) drugs to suppress their male hormones and stop them fuelling the disease.
But new research from the Karolinska Institute in Sweden suggests this may be a mistake.
A comparison between two groups of 699 men with advanced prostate cancer showed that twice as many of those who both underwent surgery and received hormone treatment were still alive after 14 years.
Death from prostate cancer was two and a half times more common among men given the standard hormone therapy and not offered surgery.
In total, 231 men receiving ADT alone had been killed by their disease at the end of 14 years compared with 93 men treated with surgery followed by ADT.
Currently, men diagnosed with advanced prostate cancer typically survive around five years.
The findings were presented at the annual meeting of the European Association of Urology in Stockholm.
Study leader Peter Wiklund, from the Karolinska Institute, said: “What we are presenting here is not only new but highly controversial, and will represent a paradigm shift in our understanding and management of advanced prostate cancer.
“Should the improved survival that combined treatment shows in this study be a real effect, then this could revolutionise the management of advanced prostate cancer. Our next step is to perform a multi-centre randomised controlled trial to evaluate this question with the highest level evidence.”
Prasanna Sooriakumaran, a British member of the team from Oxford University, said: “A number of novel agents have been proposed in recent years, and these improve survival by months. Our research has the potential to improve survival outcomes by more than these novel treatments, and thus could represent a major advance in the field.”
Mikis Euripides, director of policy at Prostate Cancer UK, said: “While this is a valid line of enquiry, the evidence from this retrospective analysis isn't enough to conclude that men with advanced prostate cancer would be better off having a radical prostatectomy, a major operation which can leave severe side effects.
“However, the findings do indicate that there may be value in conducting a larger clinical trial.”