Surgery offers best survival for prostate cancer

By Anthony J. Brown, MD

NEW YORK (Reuters Health) - Removal of the prostate gland, a surgical procedure also known as "prostatectomy," offers longer survival rates than radiation therapy, careful monitoring, or hormone therapy for men with "localized" prostate cancer, a common form of the disease in which the cancer has not yet spread to other organs, new research shows.

"We observed that prostatectomy was associated with the best long term prognosis -- in particular, for younger patients and patients with (aggressive) tumors," senior author Dr. Christine Bouchardy, from Geneva University, Switzerland, told Reuters Health. "We are not very surprised that prostatectomy offers the best chance of cure at long term, but we should wait for results from (clinical) trials to confirm this."

The study, which is reported in the Archives of Internal Medicine, involved 844 men with localized prostate cancer, including 158 who underwent prostatectomy, 205 had radiation therapy, 378 had careful monitoring and treatment if needed, 72 received hormone therapy, and 31 had other types of therapy.

In general, the type of therapy had little impact on the 5-year survival rate from prostate cancer. The exception was treatment with hormone therapy alone, which resulted in a worse 5-year survival than the other therapies.

At 10 years, however, the survival differences emerged between the groups. Patients treated with radiation therapy or followed with careful monitoring had prostate cancer-related survival rates of 75 and 72 percent, respectively, whereas for those treated with surgery it was 83 percent.

Further analysis showed that the inferior survival seen with radiation therapy and close monitoring was largely confined to patients younger than 70 years or those with aggressive cancers.

"According to this study, surgery appears to offer prostate cancer patients the best survival chances at long term," Bouchardy said. "Given the lack of consensus on the best treatment for patients and the important therapeutic disparities in routine health care practice, results of this study can help patients and practitioners in their decision making."

SOURCE: Archives of Internal Medicine, October 8, 2007.