Prostate Cancer Mortality Rate Lower with Surgery Than Other Treatment Options

Prostate cancer patients who opt for radiation treatment, hormone therapy, observation, or other forms of treatment for localized prostate cancer have a higher rate of death within 10 years than patients who have undergone surgery for prostate cancer, according to a recent Swiss study, published in the Archives of Internal Medicine.

As there have not yet been any notable randomized trials for prostate cancer treatments, treatment decisions are currently strongly influenced by the patient and physicians’ personal perferences and experiences, say the study’s authors.

Researchers 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.

After 10 years, survival rates were 83 percent for those who underwent surgery to remove the prostate (prostatectomy), 75 percent for radiation therapy, 72 percent for watchful waiting, 41 percent for hormone therapy and 71 percent for other treatments.

"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 wrote.

The increased mortality associated with radiotherapy and watchful waiting was primarily observed in patients under 70 years of age and in patients with poorly differentiated tumors, or tumors that have certain cellular characteristics and are more likely to spread aggressively.

While the authors recognize that their study can be improved through randomized clinical trials, they noted that "until clinical trials provide conclusive evidence, physicians and patients should be informed of these results and their limitations."

Source: Archives of Internal Medicine  2007;167(18):1944-1950.

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