According to an article recently published in the journal Urology, treatment with a radical prostatectomy appears to provide greater survival than radiation or conservative management of early prostate cancer. However, these results need to be confirmed by a clinical trial that directly compares the different treatment modalities.

Patients diagnosed with localized prostate cancer (cancer confined to the prostate) often must choose among “watchful waiting”, more aggressive treatment with radiation or surgery (radical prostatectomy), or participation in a clinical trial.

Watchful waiting or conservative management refers to an approach in which no treatment is administered until a specified point of disease progression. Although previous studies have indicated that active treatment provides superior long-term outcomes to watchful waiting in early prostate cancer, research continues to compare these strategies as active treatment is associated with side effects such as erectile dysfunction and urinary incontinence.

Researchers from several institutions in the United States recently conducted a clinical study to compare outcomes among men with early prostate cancer who were either treated with conservative management, radiation therapy, or a radical prostatectomy. This study included more than 3,000 men with early prostate cancer who were diagnosed from 1980 to 1997.

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  • At 15 years overall survival was 35% for men who underwent conservative management, 50% for men who underwent radiation therapy, and 65% for those who underwent a radical prostatectomy.
  • Patients treated with conservative management had a 13% increased risk of dying specifically from prostate cancer over those treated with a radical prostatectomy and an 8% increased risk of dying specifically from prostate cancer than those treated with radiation therapy.
  • Patients treated with radiation therapy had a 5% increased risk of dying specifically from prostate cancer over those treated with a prostatectomy.
  • Patients treated with radiation therapy had a survival increase of 4.6 years over those treated with conservative management, while those treated with a prostatectomy had a survival increase of 8.6 years over those treated with conservative management.

The researchers concluded that a radical prostatectomy and radiation therapy appear to improve survival compared to conservative management in the treatment of localized prostate cancer. However, since this was a review of data, the researchers caution that clinical trials directly comparing these treatment strategies are needed to truly determine the effectiveness of each.

Reference: Tewari A, Raman J, Chang P, et al. Long-term survival probability in men with clinically localized prostate cancer treated with conservatively or with definitive treatment (radiotherapy or radical prostatectomy). Urology. 2007; 68: 1268-1274.