Cancer Research Lab

Compared with conservative “watchful waiting,” which is often recommended for men with high-grade prostate cancer because of the difficulty of treating it, radiation therapy or radical prostatectomy can lead to a significant improvement in survival, New York-based researchers report.

“Patients with the most aggressive non-metastatic prostate cancers — Gleason scores 8-10 — if treated with prostatectomy or radiation, can expect to live more than 14 years,” lead investigator Dr. Ashutosh Tewari said. “Those treated conservatively will live, on average, less than 7 years.”

Dr. Tewari and associates at New York Presbyterian Hospital, Weill Medical College of Cornell University conducted a retrospective study of 453 prostate cancer patients with a Gleason score of 8 or higher. The findings are reported in the March issue of the Journal of Urology.

Of this group, 197 (44%) were treated conservatively, 137 (30%) received radiation therapy and 119 (26%) underwent radical prostatectomy. Corresponding median overall survival times were 5.2, 6.7 and 9.7 years.

Median cancer-specific survival was 7.8 years for conservative therapy and more than 14 years for radiation therapy and radical prostatectomy. “The risk of cancer-specific death following radical prostatectomy was 68% lower than for conservative treatment and 49% lower than for radiation therapy,” Dr. Tewari’s group found.

The researchers conclude that “even high-grade cancers are potentially curable. Retrospectively, there is a significant difference in long-term outcome among patients undergoing conservative treatment, radiation therapy and radical prostatectomy.”