Prostate Cancer: Surgery Best Option?
Study Shows 10-Year Prostate Cancer Survival Best When Patients Choose Surgery
Oct. 8, 2007 -- Men who choose surgery for early prostate cancer are more
likely to be alive 10 years later than men who opt for other treatments, a
Swiss study shows.
In early prostate cancer, cancer cells haven't spread beyond the prostate.
There are several different treatment options: surgical removal of the prostate
(prostatectomy), external-beam radiation therapy, implantation of radioactive
seeds (brachytherapy), freezing the tumor (cryotherapy), hormone therapy, and watchful
a treatment for prostate cancer isn't easy. Each treatment has a different
set of benefits and a different set of risks. But there's a growing body of
evidence showing that men who opt for surgery may have better odds of long-term
The latest piece of this evidence comes from Geneva University researchers
Christine Bouchardy, MD, MPH; Elisabetta Rapiti, MD, MPH; and colleagues. They
analyzed data on all 844 prostate cancer patients diagnosed with early prostate
cancer from 1989 through 1998 in Geneva, Switzerland.
The bottom line: Men who underwent surgery were 2.3 times less likely to die
of prostate cancer than men treated with external radiation. Why did
surgery seem to work better?
Prostate Surgery May Leave More Options Open
"It is related to the burden of disease," Rapiti tells WebMD.
"The more of the tumor you are able to take away and the less you leave,
the less chance you have for metastases [cancer cells that spread to other
parts of the body]."
And Bouchardy says that even if surgery doesn't get every cancer cell,
surgery patients with recurrent disease have more options than radiation
patients with recurrent disease.
"Recurrence after surgery is easier to treat successfully -- with
irradiation or irradiation plus hormonal therapy -- than after irradiation,
when only hormonal therapy remains as an option," she tells WebMD.
Ash Tewari, MD, is director of prostate cancer-urologic oncology outcomes at
the Brady Urology Institute at Cornell University. Tewari has been studying
long-term outcomes after prostate cancer treatment. He was not involved in the
"If you look not only at this study but at the studies we brought out in
the last three or four years, in terms of survival for 10 or even 15 years,
there is a distinct advantage in patients who underwent surgery for localized
prostate cancer," Tewari tells WebMD. "This has implications for
patients comparing different treatment options."
Surgery is not the best choice for every patient. The Swiss researchers
found that elderly patients and those with very early-stage tumors did just as
well after radiation therapy as surgery patients.
"Radiation therapy remains an option for patients with short life
expectancy, with contraindication to surgery, or who refuse surgery,"
Bouchardy is quick to point out that survival isn't the only factor to
consider when weighing prostate cancer treatment options. A man must also
quality of life after treatment.
As do the Swiss researchers, Tewari warns that only a clinical trial, in
which matched patients are randomly assigned to different treatments, can prove
whether one treatment offers better long-term survival than another.
"But this is a well-conducted study in which it appears that aggressive
prostate cancers in people with long life expectancy may have some life
advantage if they get the cancer out of the body," he says.
The Swiss study appears in the Oct. 8 issue of Archives of Internal