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Outcomes/Effectiveness Research

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Prostate removal is better than radiation or watchful waiting for elderly men with local/regional prostate cancer

Radical prostatectomy (surgical removal of the prostate) prolongs survival more than radiation or watchful waiting for elderly men with local/regional prostate cancer who have at least 10 years of life expectancy, concludes a new study. The University of Texas researchers followed up to nearly 12 years 5,845 men who were diagnosed in 1992 with local/regional stage prostate cancer at age 65-74 and who were potential candidates for radical prostatectomy.

The researchers identified the men from the population-based Surveillance, Epidemiology, and End Results (SEER) and Medicare linked data. Overall, 10-year all-cause survival rates were the highest for men who underwent radical prostatectomy (81 percent), followed by radical prostatectomy in combination with radiotherapy (67.6 percent), radiotherapy (60.5 percent), and watchful waiting (50.7 percent). There was a similar pattern for 10-year prostate-specific cancer survival. After adjusting for other factors affecting mortality such as age, ethnicity, hormone therapy, chemotherapy, and coexisting illnesses, men who underwent radical prostatectomy or radical prostatectomy plus radiation therapy were only one-third as likely to die from all causes as men who received watchful waiting. Nevertheless, any benefit of radical prostatectomy on survival must be weighted against the potential side effects of the surgery such as impotence and urinary incontinence.

The results may not be generalizable to younger men with prostate cancer. The study was supported in part by the Agency for Healthcare Research and Quality (HS16743).

See "Long-term survival after radical prostatectomy compared to other treatments in older men with local/regional prostate cancer," by Liqian Liu, M.D., M.S., Ann L. Coker, Ph.D., Xianglin L. Du, M.D., Ph.D., and others in the June 2008 Journal of Surgical Oncology 97, pp. 583-591.

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