Conclusions Our Study Results Suggest That Surgery Offers The Best Chance Of Long-Term Prostate Can

Arnaud Merglen, MD; Franz Schmidlin, MD; Gerald Fioretta, BSc; Helena M. Verkooijen, MD, PhD; Elisabetta Rapiti, MD, MPH; Roberto Zanetti, MD; Raymond Miralbell, MD; Christine Bouchardy, MD, MPH

Arch Intern Med. 2007;167:1944-1950.

Background  No clear guidelines exist for managing localized prostate cancer because clinical studies have not yet established which treatment provides the best long-term outcome. We assessed the effect of treatment on prostate cancer–specific mortality considering the determinants of treatment and prognosis.

Methods  The population-based cohort included all 844 patients having a diagnosis of localized prostate cancer between January 1, 1989, and December 31, 1998, in Geneva, Switzerland. Treatments included prostatectomy (n = 158), radiotherapy (n = 205), watchful waiting (n = 378), hormone therapy (n = 72), and other types of therapy (n = 31). We compared survival curves using the log-rank test. With multivariate Cox proportional hazards analysis and propensity score methods, we evaluated the independent effect of treatments on prostate cancer–specific mortality.

Results  Treatment options only slightly influenced 5-year prostate cancer–specific mortality but had an important effect on long-term mortality. Ten-year specific survival was 83% (95% confidence interval [CI], 73%-93%), 75% (95% CI, 67%-83%), and 72% (95% CI, 66%-80%) for patients who underwent surgery, radiotherapy, and watchful waiting, respectively (P < .001). 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 (multiadjusted hazard ratio, 2.3 [95% CI, 1.2-4.3] and 2.0 [95% CI, 1.1-3.8], respectively). 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 (Gleason score  7; reference, 1 [best]-10 [worst]). Patients who received hormone therapy alone already had an increased risk of prostate cancer–specific mortality at 5 years (hazard ratio, 3.5 [95% CI, 1.4-8.7]).

Conclusions  Our study results suggest that surgery offers the best chance of long-term prostate cancer–specific survival, in particular for younger patients and patients with poorly differentiated tumors. Until clinical trials provide conclusive evidence, physicians and patients should be informed of these results and their limitations.

You can't make a valid comparison unless you know exactly and to what dose the radiation patients were treated.  Based on the dates the patients were accrued, many were give old style radiation treatments, many without ADT.

Not Apples to Apples, classical prostatectomy has not changed in 50 to 60 years.  The other methods have.   Because of that this information is dated.  Actually though their results using the 2d and early 3d methods are pretty good.

AGE is no longer a selection criteria for prostate cancer.

It is interesting to note they don't mention Mortality and Morbidity of surgery , nor the chance of permanent incontinence in the study or quality of life of the survivors of both methods.  Since the results now are equal , that is the basis for treatment choice ie. risk of longterm effects.

Terricida,

   Obviously a uro.  This is the problem with retrospective studies, by definition they look at the past.  They are valuable only in evaluating what was done AT THE TIME.  They can indicate new directions that need to be taken to IMPROVE results.  However, this is dated, it is not new data at all, every retrospective study during this time period would show the same thing.  The treatment has changed and improved since the cut off of the review and NEW prospective studies, some randomized, that the new Radiation treatments are much better, with fewer severe side effects and equal cure rates.  And just like surgical failures , radiation failures can at times be salvaged.