This article compared the survival effect of two therapeutic approaches for patients with confined prostate cancer: radical prostatectomy (complete removal of the prostate) and active surveillance. Early radical prostatectomy (RP) was found to reduce the number of cancer-related deaths, particularly in patients with high risk prostate cancer.
Patients with confined (localized to the gland, or stages I and II) prostate cancer may choose to be treated with surgery (RP) or radiation or they can delay treatment (active surveillance with regular check-ups, rectal exams and blood tests for PSA). Delaying treatment has the benefit of a better well-being, while risking the progression of the disease. On the other hand, RP offers a real cure for prostate cancer, despite the risks and long-term complications of surgery.
The present study included 44,694 men with confined prostate cancer. 47.8% had RP and 50.2% undergone active surveillance between 1992 and 2005. Prostate cancer mortality rates (death caused by the cancer) were evaluated 10 years post diagnosis. Rates were analyzed (stratified) based on three categories: prostate cancer risk group, age, and health status (other illness). Prostate cancer risk group was determined by tumor characteristics. High risk tumors have features suggestive of aggressiveness, such as larger tumors; higher Gleason scores.
Men treated with RP had more favorable cancer mortality rates, regardless of the category tested. Patients with high risk prostate cancer benefited the most from radical prostatectomy: cancer mortality rate was 5.2% compared with 12.8% under active surveillance. Older patients (75-80 years) seemed to gain more benefit from early RP compared to younger ones.
In this study, radical prostatectomy has demonstrated superior effect on 10-years survival over the approach of delayed therapy. The study found RP more favorable for patients with high risk prostate cancer. However, other important factors such as the potential impact of treatment on the quality of life and patient’s status should be carefully considered for each individual patient in the treatment decision-making process.
Published By :
Journal of Urology
Date :
Jul 01, 2012
