Initial Prostatectomy in Early-Stage Prostate Cancer May Improve Cancer-Free Survival Compared to Watchful Waiting


Initial Prostatectomy in Early-Stage Prostate Cancer May Improve Cancer-Free Survival Compared to Watchful Waiting

According to a recent article published in

The New England Journal of Medicine, patients with early-stage prostate cancer who are initially treated with a radical prostatectomy appear to have improved cancer-free survival, but equivalent overall survival, compared to patients who initially undergo watchful waiting.

The prostate is a walnut-sized male sex gland that is located between the rectum and the bladder and is responsible for forming a component of semen. Patients with early-stage prostate cancer have cancer that has not spread outside the prostate. Early-stage prostate cancer may be treated with several forms of therapy, often including one of the following: radical prostatectomy (surgical removal of the prostate), radiation therapy, watchful waiting (treatment upon cancer progression) and/or cryosurgery. Several clinical trials are ongoing to directly compare these different treatment options and long-term outcomes in patients with early-stage prostate cancer, as no results have yet determined a definite survival advantage of one treatment over another.

Presently, prostate cancer is often diagnosed from a screening procedure measuring prostate-specific antigen (PSA) levels. Prostate-specific antigens are proteins that are normally shed by prostate cells and can be detected in the bloodstream. If PSA levels are elevated, it is often an indication of the presence of prostate cancer. Patients with elevated PSA levels undergo further testing to determine the existence of prostate cancer or a benign condition. Historically, prostate cancer was often detected clinically, meaning an enlarged prostate gland was found during a rectal exam. Elevated PSA levels can be indicative of prostate cancer before the prostate gland is enlarged, leading to earlier detection.

Researchers from the Scandinavian Prostatic Cancer Group recently finished a clinical trial involving nearly men with early-stage prostate cancer who were treated at 14 different medical facilities. Patients were initially treated with either a radical prostatectomy (347) or the watchful waiting approach (348) and were allowed to receive different therapies if their cancer progressed or recurred. Approximately 6 years following initial therapy, death from prostate cancer occurred in only 4.6% of patients treated with surgery, compared to 8.9% of patients undergoing watchful waiting. Eight years following initial therapy, the rate of developing distant metastases (spread of cancer) was 14% greater in patients who underwent watchful waiting than in patients treated with surgery. Local recurrences at 8 years occurred in approximately 20% of patients treated with a prostatectomy, compared to 60% of patients who underwent watchful waiting. However, there was no overall survival benefit in patients treated with a radical prostatectomy, as overall survival was the same between the two groups of patients. In addition, quality of life was reported to be similar between the two groups of patients.

These researchers conclude that this study indicates that initial therapy with a radical prostatectomy in early-stage prostate cancer may improve cancer-free survival, but not overall survival, compared to watchful waiting. However, the researchers caution that prostate cancer in these patients was detected clinically, not through PSA screening, which may result in different outcomes as PSA screening may detect cancer earlier. Patients with early-stage prostate cancer may wish to discuss the results of this trial with their physician as well as the risks and benefits of all treatment options or the participation in a clinical trial evaluating other novel therapeutic options. Two sources of information regarding ongoing clinical trials include the National Cancer Institute (

cancer.gov) and

www.eCancerTrials.com. eCancerTrials.com also provides personalized clinical trial searches on behalf of patients.

Reference: Holmberg L, Bill-Axelson A, Helgesen F, et al. A randomized trial comparing radical prostatectomy with watchful waiting in early prostate cancer.

The New England Journal of Medicine. 2002;347:781-789.

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