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Men with localized prostate cancer who undergo surgery may live longer than those who undergo radiation or observation

Ten years after diagnosis of localized prostate cancer, men who undergo surgical removal of the prostate (radical prostatectomy) may have a survival advantage over men who undergo radiation or observation, suggests a new study. In addition, this survival advantage for surgery appears to occur in men in all risk categories, including those with high-grade prostate cancer (select for Figure).

For example, men undergoing radical prostatectomy and classified as being at low, intermediate, or high risk for cancer progression had a 3 percent, 6 percent, and 10 percent mortality rate, respectively, from prostate cancer 10 years later. Men undergoing radiation therapy had a 7, 12, and 20 percent 10-year mortality rate from prostate cancer. Sixteen percent of men who elected observation died from prostate cancer at 10 years.

Superior survival of men undergoing surgery may reflect a selection bias favoring younger, health-conscious men who underwent prostate-specific antigen (PSA) testing. For example, men who underwent surgery were younger, had more favorable histology (tissue structure), and lower pretreatment PSA levels compared with patients undergoing radiation, explains Peter C. Albertsen, M.D., of the University of Connecticut Health Center.

The study results challenge the concept that men with high-grade prostate cancer are less likely to benefit from radical surgery. However, the study did not control for confounding factors that may have affected survival rates, such as percentage of cancer-positive biopsies, pretreatment rise of PSA, and hypogonadism (inadequate functioning of the testes). Also, the men in this trial were not randomized.

The study's findings were based on analysis of data on men (75 years or younger) diagnosed with clinically localized prostate cancer between 1990 and 1992 from the Connecticut Tumor Registry. The researchers obtained information from physician offices about 802 men who underwent surgery, 702 men who underwent external beam radiation therapy, and 114 who underwent observation only, and their subsequent medical outcomes.

The study was supported in part by the Agency for Healthcare Research and Quality (HS09578).

See "13-year outcomes following treatment for clinically localized prostate cancer in a population based cohort," by Dr. Albertsen, James A. Hanley, Ph.D., David F. Penson, M.D., M.P.H., and others in the March 2007 Journal of Urology 177, pp. 932-936.

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