Treatment with radiotherapy and radical surgery found beneficial.
Two recent studies suggest that men with localized prostate cancer have a survival advantage if they are treated rather than managed conservatively.
In one study, Ashutosh Tewari, MD, of the New York-Presbyterian Hospital-Weill Cornell Medical Center in New York, and his colleagues examined data on 3,159 men (mean age 65.7 years) with localized tumors. The study revealed an overall 15-year survival rate of 35%, 50%, and 65% for conservative management, radiotherapy, and radical prostatectomy, respectively, after adjusting for age, race, tumor grade, comorbid illness and other potential confounders.
Radiotherapy and radical prostatectomy were associated with 33% and 59% reduced mortality risk at 15 years compared with conservative management. Additionally, the increase in the survival duration was 4.6 years for radiotherapy and 8.6 years with radical prostatectomy.
“The reduction in mortality was greatest in patients with poorly differentiated cancer undergoing prostatectomy, but decreases in mortality occurred in all subsets of patients undergoing definitive treatment,” the researchers noted in Urology (2006;68:1268-1274).
Radiotherapy and radical prostatectomy decreased the mortality rate from prostate cancer by 38% and 63%, respectively, compared with conservative management.
The other study examined data on 44,630 men (aged 65-80 years) from the Surveillance, Epidemiology, and End Results (SEER) Medicare database. The men had organ-confined and well or moderately-differentiated tumors. In this cohort, 32,022 men received treatment with either radical prostatectomy or radiation therapy and 12,608 received observation.
At the end of the 12-year study period, 37% of the observation group died compared with 23.8% of patients treated with radical prostatectomy or radiotherapy during the first six months after diagnosis, which translated into a 31% lower mortality risk associated with treatment.
“This study suggests a survival advantage is associated with active treatment for low- and intermediate-risk prostate cancer in elderly men aged 65 to 80 years,” the authors concluded in the Journal of the American Medical Association (2006;296:2683-2693).
The researchers, led by Yu-Ning Wong, MD, of the Fox Chase Cancer Center in Philadelphia,
cautioned that, because their study was observational and thus potentially subject to selection bias and confounding, “results must be validated by rigorous randomized controlled trials of elderly men with localized prostate cancer before the findings can be used to inform treatment decision.”