FORT LAUDERDALE, Fla--The duration of anticipated survival after
a prostate cancer diagnosis, and therefore the period of time
at risk in the disease, is unique to prostate cancer in the influence
it exerts on selection of therapy.
If life expectancy is less than 5 years, in the asymptomatic patient,
observation is "prudent, appropriate, and good therapy,"
said Christopher Logothetis, MD, in his presentation of the preliminary
prostate cancer guideline developed for the National Comprehensive
Cancer Network (NCCN).
The evidence that therapy can alter the course of prostate cancer
in the first 5 years is very limited, and thus the goal in these
patients is to avoid symptoms, "and that is defeated by early
treatment of the asymptomatic patient," he said at the NCCN's
first annual conference.
On the contrary, if life expectancy is greater than 5 years, the
clinician must try to divide patients into risk categories and
select appropriate therapy.
In the NCCN guideline, based on stage, Gleason score, and degree
of elevation of the PSA, patients are divided into low, intermediate,
or high probability of having organ-confined disease, the predictor
of adverse outcome after local therapy, said Dr. Logothetis, of
the M.D. Anderson Cancer Center.
The Prostatectomy Paradox
The first questions for the prostate panel from the conference
audience related to the logic of choosing initial therapy. A physician
from Wisconsin asked for an explanation of the pros-tatectomy
paradox: "If a patient has a high probability of organ-confined
disease and life expectancy less than 10 years, observation or
radiotherapy is recommended and prostatectomy is considered a
poor option. But if expected survival is longer, why does prostatectomy
then become a good treatment?" he asked.