Surgery May Offer Best Chance Of Long-term Prostate Cancer Survival

Prostate cancer treatments are still being debated because they have not yet been compared in a randomized trial, in which men would be randomly assigned to one treatment or another, according to background information in the article. "Therefore, treatment choice is strongly influenced by patient and physician personal preferences and experiences," the authors write.

Arnaud Merglen, M.D., of Geneva University, Switzerland, and colleagues used data from the Geneva Cancer Registry to assess all 844 patients diagnosed with localized (not yet spread) prostate cancer in Geneva between 1989 and 1998. Of those men, 158 received prostatectomy, or surgery to remove all or part of the prostate; 205 had radiation treatment (radiotherapy); 378 chose watchful waiting, which entails active follow-up and treatment if the disease progresses; 72 underwent hormone therapy; and 31 had another type of therapy.

The average follow-up was 6.7 years (range zero to 15.8 years), and 47 patients (5.6 percent) left Geneva and the study before the study concluded.

"At 10 years, patients treated with radiotherapy or watchful waiting had a significantly increased risk of death from prostate cancer compared with patients who underwent prostatectomy," the authors write. Ten-year survival rates from prostate cancer were 83 percent for prostatectomy, 75 percent for radiotherapy, 72 percent for watchful waiting, 41 percent for hormone therapy and 71 percent for other treatment. "The increased mortality associated with radiotherapy and watchful waiting was primarily observed in patients younger than 70 years and in patients with poorly differentiated tumors," or tumors that have certain cellular characteristics and are more likely to spread aggressively.

"Until clinical trials provide conclusive evidence, physicians and patients should be informed of these results and their limitations," the authors conclude.

Reference: Arch Intern Med. 2007;167(18):1944-1950. 

This study was supported in part by a PROSPER (Program for Social Medicine, Preventive and Epidemiological Research) grant from the Swiss National Science Foundation.