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Prostatectomy provides greatest long-term survival in patients with localized prostate cancer, study data suggest

Monday, November 12 2007 | Comments

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What's This? Patients with localized prostate cancer who undergo radical prostatectomy may have a better chance at long-term prostate cancer-specific survival than those treated with other modalities, according to study findings.

"No clear guidelines exist for managing localized prostate cancer because clinical studies have not yet established which treatment provides the best long-term outcome," the authors of the study wrote.

Researchers examined data from a population-based cohort comprised of all 844 patients who received a diagnosis of localized prostate cancer from 1989 to 1998 in Geneva, Switzerland. Treatments included prostatectomy (radical, retropubic, or perineal; n=158), external radiotherapy (n=205), watchful waiting (n=378), hormone therapy (surgical or hormonal castration; n=72), and other types of therapy (n=31). No patients underwent brachytherapy in the study. The mean follow-up duration was 6.7 years.

Five-year prostate cancer-specific survival rates were 94% (95% CI, 90%-98%) among patients who underwent surgery, 93% (95% cI, 89%-97%) among those who received radiotherapy, 86% (95% CI, 82%-90%) among those managed with watchful waiting, 71% (95% CI, 59%-83%) among those who received hormone therapy alone, and 71% (95% CI, 53%-89%) among those who received other combinations of therapy.

Compared with patients who underwent prostatectomy and watchful waiting, the 5-year risk of mortality was not significantly different among patients who received radiotherapy, but was significantly greater among those who received hormone therapy (HR, 3.5; 95% CI, 1.4-8.7) and those who received other combinations of therapy (HR, 5.8; 95% CI, 2.1-16.0).

At 10 years, the survival advantage with surgery was more pronounced; specifically, 10-year survival rates were 69% (95% CI, 59%-79%) among those who underwent prostatectomy, 54% (95% CI, 50%-62%) among those who received radiotherapy, and 35% (95% CI, 29%-41%) for those managed with watchful waiting (log-rank test, P<.001).

Compared with patients who underwent prostatectomy, the 10-year risk of mortality was 2.3-fold (95% CI, 1.2-4.3) greater among patients who received radiotherapy, 2-fold (95% CI, 1.1-3.8) higher for those managed with watchful waiting, 4.4-fold (95% CI, 2.2-8.8) higher for who received hormone therapy alone, and 3.1-fold (95% CI, 1.3-7.5) higher for those who received other combinations of therapy.

Increased long-term risk of mortality within patients managed with radiotherapy or watchful waiting was primarily confined to men aged <70 years (HR, 6.7; 95% CI, 2.2-20.7) and those with poorly differentiated tumors (HR, 5.2; 95% CI, 1.3-20.6), the authors noted. (Merglen A, et al. Arch Intern Med 2007;167:1944-1950.)

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