Patients with early prostate cancer who are treated with initial surgery appear to have reduced death from prostate cancer compared with those who undergo watchful waiting as initial therapy. These results were recently published in the Journal of the National Cancer Institute.
Early prostate cancer refers to prostate cancer that has not spread from the prostate to distant sites in the body but is limited to the prostate and nearby lymph nodes. Standard therapy for early prostate cancer may include surgery (radical prostatectomy), radiation therapy, watchful waiting (also referred to as conservative management, in which there is no treatment until disease progression), and hormone therapy. Optimal treatment for early prostate cancer is still under debate, though it appears that individualized approaches may provide the best outcomes. Several variables are considered when selecting treatment options for early prostate cancer; these include age, aggressiveness of cancer, extent of spread, other existing medical conditions, and side effects of therapy.
Researchers from Scandinavia recently conducted a clinical trial that compared initial therapy with a radical prostatectomy with watchful waiting among men with early prostate cancer. This trial included 695 men who had been diagnosed between 1989 and 1999 and were followed for a median of nearly 11 years.
- 13.5% of men who received an initial radical prostatectomy had died of prostate cancer compared with 19.5% of men who underwent initial watchful waiting.
- After approximately 10 years, the rate of death caused by prostate cancer stabilized between the two groups of men.
- At 12 years 19.3% of men who received an initial radical prostatectomy and 26% of men who underwent initial watchful waiting had distant spread (metastasis) of their cancer.
- Among the group of men who underwent an initial radical prostatectomy, those whose cancer extended outside the capsule of the prostate had 14 times the increased risk of death from the disease than those whose cancer had not extended outside the capsule of the prostate.
The researchers concluded that, when compared with watchful waiting as initial therapy for men with early prostate cancer, “Radical prostatectomy reduces prostate cancer mortality and risk of metastases with little or no further increase in benefit 10 or more years after surgery.” However, it is important for patients with early prostate cancer to discuss their individual risks and benefits of all treatment options with their healthcare provider.
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Reference: Bill-Axelson A, Holmberg L, Filen F, et al. Radical Prostatectomy Versus Watchful Waiting in Localized Prostate Cancer: the Scandinavian Prostate Cancer Group-4 Randomized Trial. Journal of the National Cancer Institute [early online publication]. August 11, 2008. doi:10.1093/jnci/djn255.
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