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Title: Prostatectomy Improves Outcome in Men With Prostate Cancer Compared With No Treatment
URL: http://www.pslgroup.com/dg/228386.htm
Doctor's Guide
August 12, 2008

CARY, NC -- August 12, 2008 -- Men with early prostate cancer who undergo radical prostatectomy have a lower rate of death due to prostate cancer than men who are followed without treatment, according to a randomized, controlled trial published in the August 12 online issue of the Journal of the National Cancer Institute.

The benefit from the surgery, with respect to prostate cancer death rates, remained constant beyond 10 years, but the overall death rates in the 2 groups were not statistically different. The applicability of the results to the current generation of prostate cancer patients is unclear, however, because few of the cancers treated in the trial were discovered by prostate-specific antigen (PSA) screening.

With a median follow up of 10.8 years, the cumulative incidence rate for prostate cancer death was 13.5% in the surgery arm and 19.5% in the watchful-waiting arm, for an absolute reduction of 6%. The benefit, in terms of absolute risk reduction, did not increase after the first 10 years following treatment. For those patients followed at least 12 years, 12.5% of the men in the surgery group died due to prostate cancer compared with 17.9% of the men in the watchful-waiting group, for an absolute reduction of 5.4%. Overall mortality at 12 years, however, was not statistically significantly different in the 2 arms at 32.7% and 38.5%, respectively.

"Contrary to our predictions based on shorter follow-up, the absolute difference in cumulative incidence of distant metastasis and prostate cancer death did not further increase after 7 years of follow-up," the authors wrote.

The authors note that it is not clear whether their data are applicable to men whose cancer is detected in the era of PSA screening because most of the men in their trial had palpable tumours at diagnosis.

"In settings with a large proportion of PSA-detected tumours, the relative reduction in risk of death following radical prostatectomy might be somewhat larger or similar to that in our study, but the absolute reduction would be smaller," the authors noted.


SOURCE: Journal of the National Cancer Institute

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