Cancer Research Lab

Both radical prostatectomy and radiotherapy appear to result in significantly higher survival rates compared with conservative management in patients with clinically localized prostate cancer, according to the results of a large study conducted at the Henry Ford Health System in Detroit.

Dr. Ashutosh Tewari, of New York-Presbyterian Hospital-Weill Cornell Medical Center in New York City, and colleagues studied 3,159 men, who were 75 years of age or younger with biopsy-confirmed, clinically localized prostate cancer, treated between 1980 and 1997.

The overall 15-year survival rate was 35% with conservative management, 50% with radiotherapy and 65% with radical prostatectomy, the investigators report in the December issue of Urology. Prostate cancer-specific survival rates were 79%, 87% and 92% with conservative management, radiotherapy and surgery, respectively.

The adjusted relative risk of death at 15 years was 0.67 for radiotherapy and 0.41 for prostatectomy compared with conservative management.

Survival duration was increased 4.6 years with radiotherapy and 8.6 years with radical prostatectomy.

The investigators point out that one of the strengths of this study was the size, the lengthy follow-up and the inclusion of black patients. Subgroup analysis showed that risk ratios were the same across all subgroups analyzed, including race, age, tumor grade, co-existing morbidities and income.

Because this was a retrospective trial, Dr. Tewari and colleagues caution that randomized clinical trials are still needed confirm the survival benefits of each of these three treatment approaches.