Surgery Offers Better Long-Term Prostate Ca Survival Than Other Options

VERY interesting new study!   Oct 18, 2007

Urology Times E-News

 

Men who have prostate cancer surgery, especially if they are younger or have cancers with certain tumor cell characteristics, appear less likely to die of the disease within 10 years than are men who choose other treatment options, according to a report in Archives of Internal Medicine (2007; 167:1944-50).

Arnaud Merglen, MD, of Geneva University, Switzerland, and colleagues used data from the Geneva Cancer Registry to assess all 844 patients diagnosed with localized prostate cancer in Geneva between 1989 and 1998. Of those men, 158 received prostatectomy, 205 had radiation treatment, 378 chose watchful waiting, 72 underwent hormone therapy, and 31 had another type of therapy. The average follow-up was 6.7 years, and 47 patients (5.6%) left Geneva before the study concluded.

“At 10 years, patients treated with radiotherapy or watchful waiting had a significantly increased risk of death from prostate cancer compared with patients who underwent prostatectomy,” the authors wrote.

Ten-year survival rates from prostate cancer were 83% for prostatectomy, 75% for radiotherapy, 72% for watchful waiting, 41% for hormone therapy, and 71% for other treatment.

“The increased mortality associated with radiotherapy and watchful waiting was primarily observed in patients younger than 70 years and in patients with poorly differentiated tumors,” the authors wrote. “Until clinical trials provide conclusive evidence, physicians and patients should be informed of these results and their limitations.”

 

Study is dated, started in the 80's and went thru 98,  prior to the dose escalation.  The radiation was 2d and 3d with the top dose being between 6500 and 7000 cGy.  At least 15 to 20 percent less dose than now.

At least part of the time they were also possibly adding androgen deprivation to the radiation in select cases so it would be interesting to segregate the patient out based on whether they recieved Lupron etc concurrently with irradiation.  It would also be interesting to separated the 2d from the 3d Rt patients.

It was well known prior to the last 10 years or so that surgery had the best PSA free survival for early stage prostate.  Now that is not the case.

This could be a case of the the investigators manipulating the endpoint of comparison to exclude current therapy and make surgery look better.

Also during this time brachytherapy improved markedly and as far as external beam there is no comparison to what we did up to the mid 90's and now.  That is why I say the data is dated and had been replaced with more recent studies.

20% more radation and you think your patients are going to do better in the long run. Get real.

The rest of your comments are just BS

I am 54 years old and had a radical protectomy in June of this year. My PSA was at 2.7 and rising slowy. I am now under the impression that I should have taken the wait and see approach. Having lost the ability to achieve an erection is taking a toll on me mentally. Having the ability to have children or have an ejaculation is not a concern. The fact that losing my sex drive and ability is too much to deal with. As they say, 90% of a males thoughts revolve around sexual activity means that this is something that I think about quite ofetn and sends me into a mild state of depression frequently. I have been on mild doses of Viagra for about 3 months with no results. I have taken a full dose on occation with hopes something will happen but, nothing does and it is depressing to say the least.
At this point, I am trying to put this behind me but it's difficult.