ANAHEIM, CaliforniaThe outcome of patients with clinically
localized prostate cancer can be improved with aggressive treatment, according
to two large studies presented at the American Urological Association annual
"Localized prostate cancer is often indolent, and there are no
randomized trials comparing conservative management to radical prostatectomy
and radiotherapy," said Mani Menon, MD, of the Josephine Ford Cancer
Center, Detroit. His study (abstract 621) involved a cohort of 3,159 men
younger than 76 years with clinically localized prostate cancer diagnosed
between 1980 and 1997.
"The idea that there is no survival advantage with definitive treatment
was resoundingly defeated by this analysis," Dr. Menon said.
The study was a restricted cohort analysis, which mimics randomization in
that "all patients are eligible for any treatment, and it adjusts for
baseline variables," Dr. Menon said. The study sought to determine whether
long-term survival was different between patients who were managed
conservatively and patients who were treated definitively with either
radiotherapy or radical prostatectomy. Mean follow-up was 6 years (range up to
At the time of analysis, 2,288 patients (68%) were still alive. One third of
the men who died succumbed to prostate cancer. Conservative treatment was
selected for 1,297 patients, radical prostatectomy for 963, and radiotherapy
for 899. Hormonal therapy was given to 30% of patients in the "watchful
waiting" group, 8% of patients undergoing prostatectomy, and 8% of
patients undergoing radiotherapy.
The overall adjusted survival rates at 15 years were 35% for conservative
management, 50% for radiotherapy, and 65% for radical prostatectomy. The
corresponding prostate-cancer-specific survival rates were 79%, 87%, and 92%,
respectively, he said.