Better Prostate Cancer Survival With Surgery?

Study Shows Lower Death Rate With Surgery for Aggressive Prostate Cancer

Reviewed by Brunilda Nazario, MD on May 23, 2005
From the WebMD Archives

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 Meeting.

"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 disease.


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 1997.

Three types of treatment were compared:

  • Watchful waiting. Observing the disease without treatment (197 men).
  • Radiation therapy. Using radiation to kill cancer cells (137 men).
  • 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 prostatectomy.

"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 therapy.

There was no significant difference in disease-specific survival between radiation therapy and watchful waiting, according to the study.

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SOURCES: American Urological Association's Annual Meeting, San Antonio, May 21-26, 2005. American Cancer Society: "How Many Men Get Prostate Cancer?"

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