Long-term survival probability in men with clinically localized prostate cancer

Randomized studies comparing conservative therapy to definitive therapy in men with prostate cancer (CaP) are underway, but not yet available.

Dr. Tewari and associates used the Henry Ford database to analyze the outcomes of 3,159 men treated either conservatively or with radiotherapy or radical prostatectomy (RP) in the years 1980 to 1997.Their report suggesting superior outcomes for active treatment appears in Urology .

Participants were younger than 75 years and had socioeconomic, clinical, pathological and demographic data reviewed. Men with positive bones scans were excluded. The primary endpoint was death from all causes and the secondary endpoint was death from CaP. Radiotherapy or RP had to be received by the patient within 6 months of diagnosis.

The treatment characteristics revealed that 42% were treated conservatively, 28% received radiotherapy and 30% underwent RP. Patients who underwent RP were younger and healthier (by Charlson scores). Both radiotherapy and RP men had more aggressive tumor histology. Patients from 1980 to 1990 were more likely to be treated conservatively than patients seem after 1990 (59% vs. 30%). An equal proportion of black and white men were treated conservatively, but more blacks underwent radiotherapy. Surgery patients tended to be white and live in an area of higher income.

Surgery reduced the 15-year mortality rate by 59% overall and by 47%, 60%, and 65% for men with grade 1, 2, and 3 tumors, respectively. The overall survival advantage was 8.6 years and was 6.8, 5.5, and 10.4 years for patients with grade 1, 2, and 3 disease, respectively. Radiotherapy patients also experienced a survival advantage with a reduction in mortality of 33%. The survival advantage was also found for CaP-specific survival. Radiotherapy or RP reduced the death rate from CaP by 38% and 63%, respectively, compared with patients treated conservatively. Overall, but not cancer-specific mortality correlated with Charlson index scores.

The reduction in mortality was greatest in patients with poorly differentiated CaP undergoing surgery, but decreases in death occurred in all subsets of patients undergoing definitive treatment. Referee pathologic review was not performed, although all pathology was interpreted at the single institution.

Tewari A, Raman JD, Chang P, Rao S, Divine G, Menon M

Urol 2006;68(6):1268-74

By Christopher P. Evans, MD