Radical prostatectomy and radiation therapy appear to produce similar results for the treatment of persons with prostate cancer who have PSA scores of 10.0 ng/mL or less and Gleason scores of 6 or less before treatment. This news comes from Michigan researchers who compared the 2 treatment strategies in 382 men with prostate cancer.

Cancer of the prostate, a male sex gland located near the bladder and rectum, is a type of cancer that occurs commonly in older men. One test that may be performed to help indicate whether prostate cancer is suspected is a blood test for prostate-specific antigen (PSA), a protein produced by the prostate cells. If PSA levels are high, prostate cancer is more likely, and further tests are needed for diagnosis. Once prostate cancer is diagnosed, doctors must determine the stage (the extent of disease at diagnosis) and grade (how quickly the cancer is likely to grow) of the cancer. Doctors often use a system called the Gleason score to indicate the grade of disease, with a higher score indicating the likelihood of faster growth.

Approaches to therapy may include delaying treatment until the cancer progresses or surgery, radiation therapy, brachytherapy (use of radiation implants placed in the prostate), hormone therapy, chemotherapy, and/or biologic therapy to help the immune system fight the cancer. Persons in whom the cancer is localized, or confined to the prostate gland, often undergo radiation therapy or a surgery, called a radical prostatectomy. A radical prostatectomy involves the removal of the prostate gland and some of the surrounding tissue. A pelvic lymph node dissection, the removal of the lymph nodes around the prostate, may be done before the procedure to determine whether these lymph nodes contain cancer cells. Thus far, outcomes from these 2 types of treatments appear similar; however, researchers continue to investigate whether 1 of these treatments might be more effective or result in fewer side effects.

Researchers from the William Beaumont Hospital in Royal Oak, Michigan, treated 382 men with prostate cancer, 225 with radiation therapy and 157 with a radical prostatectomy and pelvic lymph node dissection. All patients had PSA scores of 10.0 ng/mL or less and Gleason scores of 6 or less before treatment. After an average of 5.5 years, 67% of those undergoing surgery and 69% of those receiving radiation therapy did not experience any elevation of their PSA levels. The cancer was effectively controlled in 99% of persons undergoing surgery and 97% of those receiving radiation therapy.

From these findings, the researchers concluded that, in men having PSA scores of 10 ng/mL or less and Gleason scores of 6 or less before treatment, radical prostatectomy and radiation therapy appear to produce similar treatment outcomes. This suggests that it may be beneficial for persons to give particular weight to other factors, such as the potential effects on continence and potency, when making treatment decisions. Men who have prostate cancer may wish to talk with their doctor about the risks and benefits of receiving radiation therapy versus a radical prostatectomy or of participating in a clinical trial in which promising new therapies are being studied. Two sources of information on ongoing clinical trials that can be discussed with a doctor include a comprehensive, easy-to-use service provided by the National Cancer Institute (cancer.gov) and the Clinical Trials section and service offered by Cancer Consultants.com (www.411cancer.com). (Cancer, Vol 88, No 2, pp 425-432, 2000)

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