Better Prostate Cancer Survival With Surgery?
Study Shows Lower Death Rate With Surgery for Aggressive Prostate Cancer
May 23, 2005 -- Men with aggressive prostate cancer may get a survival
advantage from surgical removal of the prostate and surrounding tissue (radical
prostatectomy), compared with other options.
Three treatment options were compared by researchers including Ashutosh
Tewari, MD, director of the Robotic Prostatectomy and Prostate Cancer-Urologic
Oncology Outcomes at Cornell University's medical school. Their findings were
presented in San Antonio at the American Urological Association's 2005 Annual
"Radical prostatectomy seems to confer a survival advantage over
watchful waiting and radiation therapy in patients with high-grade (Gleason
greater than or equal to 8) prostate cancer," writes Tewari, who is also an
associate professor of urology and public health at Cornell.
The Gleason scale ranks prostate tumors; it looks at biopsied cells of the
prostate gland and examines the difference between healthy cells and those that
are malignant (cancerous). The higher the Gleason score, the more aggressive
the prostate tumor is believed to be.
Prostate Cancer Is Common
Prostate cancer is the most common type of cancer found in U.S. men (except
for skin cancer) and the No. 2 cause of men's cancer death, says the American
Cancer Society (ACS). The ACS estimates that in 2005, there will be about
232,000 new cases of prostate cancer and 30,350 men will die of the
The death rate for prostate cancer has been falling, and many men are being
diagnosed at earlier stages than in the past, says the ACS. Prostate cancer is
mainly found in older men.
It is also more common among black men than whites, and more common among
whites than Asian men. Black men are twice as likely to die of prostate cancer
as whites, says the ACS.
The study included 453 men with high-grade prostate cancer (Gleason score 8
out of 10) who were followed for about 4.5 years, on average. About 58% were
white and 42% were black; they were treated between January 1980 and December
Three types of treatment were compared:
Watchful waiting. Observing the disease without treatment
Radiation therapy. Using radiation to kill cancer cells
Radical prostatectomy. Removing the whole prostate gland
and surrounding tissue (119 men).
The study was observational; that is, the men's type of treatment wasn't
assigned by the researchers. Instead, each group's survival rates were noted by
Tewari and colleagues.
Lower Death Risk With Prostatectomy
At the study's last follow-up, 124 patients (27%) had died from prostate
cancer. Death rates were lowest in those that underwent radical
"The risk of overall death following radical prostatectomy was 32% lower
than watchful waiting and 42% lower than radiation therapy," write
researchers. In terms of cancer-specific death, the post-prostatectomy risk was
68% lower than watchful waiting and nearly half as low (49%) as radiation
There was no significant difference in disease-specific survival between
radiation therapy and watchful waiting, according to the study.