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According to a recent article in the Journal of Urology, earlier treatment with a radical prostatectomy may improve long-term outcomes in patients who develop metastatic prostate cancer; however, further trials that directly compare different treatment regimens are warranted.

The prostate is a male sex gland that is located between the bladder and the rectum and is responsible for creating a component of semen. Localized prostate cancer refers to cancer that has not spread from its site of origin. Several treatment options exist for patients with prostate cancer, including watchful waiting, surgical removal of the prostate (radical prostatectomy), radiation therapy, cryosurgery and/or hormone therapy. Metastatic prostate cancer refers to cancer that has spread to distant sites in the body. Treatment options for metastatic prostate cancer often include hormonal therapy and/or chemotherapy. Researchers are beginning to directly compare different treatment modalities in patients with different stages of prostate cancer in order to determine optimal therapeutic regimens.

Researchers from the Southwest Oncology Group Study (SWOG) conducted a clinical trial to assess different hormonal therapeutic regimens in over 1,000 men with metastatic prostate cancer. During the trial, the researchers assessed several variables which may have affected survival besides the different hormonal therapies being evaluated. They discovered that men who had previously received a radical prostatectomy had an approximate 30% reduced risk of death than men who had previously undergone other treatment modalities. Furthermore, men who had previously received radiation therapy and men who had received no previous therapy were at a higher risk of death than men who had received a prostatectomy.

These researchers state that these secondary findings appear to indicate that patients who are treated earlier in their disease with a radical prostatectomy, compared to radiation therapy or watchful waiting, may have an improved survival even though their cancer has metastasized. However, the researchers also warn that this data needs to be confirmed through future clinical trials directly comparing the two treatment strategies, as patient and/or disease characteristics may have varied between the groups of men who received different treatment. The implications of these results, if confirmed, may lead to more aggressive surgical treatment in patients with early-stage prostate cancer. Patients with prostate cancer may wish to discuss the results of this study with their physician as well as the risks and benefits of participating in a clinical trial further comparing different treatment modalities. Two sources of information regarding ongoing clinical trials include the National Cancer Institute ( and also provides personalized clinical trial searches on behalf of patients.

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Reference: Thompson I, Tangen C, Basler J, et al. Impact of previous local treatment for prostate cancer on subsequent metastatic disease.

The Journal of Urology. 2002;168:1008-1012.

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