A recent article in the New England Journal of Medicine reported that radical prostatectomy reduces the risks of metastasis (cancer spread) and disease progression among men diagnosed with early prostate cancer, when compared to the approach of watchful waiting. However, some men with early prostate cancer may be at a higher risk of developing cancer progression than others, so patients are encouraged to speak with their physician regarding their individual risks and benefits of each treatment regimen.

The prostate is a gland of the male reproductive system, which is responsible for producing some of the fluid that transports the sperm during male ejaculation. Prostate cancer is a disease in which cancer cells form in the tissues of the prostate. Early-stage prostate cancer refers to prostate cancer that has not spread from the prostate. After skin cancer, prostate cancer is the most common form of cancer diagnosed in men. However, the outlook for men diagnosed with the disease has improved, as over the past 20 years overall survival rates for all stages of prostate cancer have improved dramatically. Current treatment options for prostate cancer include watchful waiting (delay of treatment until signs of cancer progression), surgery, chemotherapy, radiation, and/or hormonal therapy. When surgery is recommended as part of the treatment plan, the surgeon may remove the entire prostate and some of the tissue around it. This procedure is known as a radical prostatectomy.

In this recent trial, researchers randomly assigned 695 men diagnosed with early prostate cancer to receive either a radical prostatectomy (347) or watchful waiting (348), as a means of treatment. The study was conducted between the years of 1989 and 1999, and follow up was completed in 2003. Researchers were interested in evaluating the cause of death due to prostate cancer as well as death from other causes, cancer metastasis or disease progression. After an average of eight years of follow up, 83 men who had been part of the group who received radical prostatectomy had died. In comparison, 106 men from the watchful waiting group had died. Among the 347 men who had undergone surgery, 30 died from prostate cancer, compared to 50 of the 348 men who were assigned to watchful waiting. Researchers noted that the incidence of death from prostate cancer rose over time and increased from 2% after five years to 5.3% after 10 years. The same trend was also seen for distant metastasis and local disease progression.

Overall, it appears that radical prostatectomy reduces deaths related to prostate cancer and reduces the risk of metastasis and local disease progression. Researchers admit that after 10 years the reduction for the risk of death is small, however, the reduced risk of metastasis and local disease progression are substantial. Furthermore, subgroups of patients with early prostate cancer may be at a higher risk of developing cancer progression than others, depending upon factors associated with their cancer. Therefore, it is important that patients with early prostate cancer speak with their physician regarding their individual risks and benefits of all treatment options for the treatment of their cancer.

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Reference: Axelson A, Holmberg L, Ruutu M, et al. Radical prostatectomy versus watchful waiting in early prostate cancer. The New England Journal of Medicine. 2005;352: 1977-1984.

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