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 meeting.
"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 19 years).
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.