Treating localized prostate cancer boosts survival

Survival rates for men with localized prostate cancer are better with either surgery or radioactive seed implantation, a treatment called brachytherapy, compared with no “definitive” treatment, investigators at the University of Utah in Salt Lake City report. This is true even among older men.

Based on the research, reported in the journal Cancer, men undergoing surgery or brachytherapy are much less likely to die of prostate cancer or any cause compared with men undergoing no definitive therapy.

“This study is the first to demonstrate an apparent overall survival advantage for brachytherapy compared with no definitive treatment, and validates prior reports that document a survival advantage for surgery,” Dr. Jonathan D. Tward and associates write.

Nonetheless, only a small number of men with localized prostate cancer will die of the disease within 10 years, the investigators note, and both surgery and brachytherapy are invasive procedures with possible lifetime side-effects.

“Factors other than survival, such as risks, side effect profiles, and quality of life weigh heavily on men deciding to undergo treatment for this disease, which is unlikely to claim their life,” the authors comment. For those who opt for definitive treatment, “both younger and older men should be counseled that either surgery or brachytherapy is appropriate.”

Using the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) database of 60,269 men diagnosed with localized prostate cancer between 1998 and 2002, Tward and colleagues assessed the rate of death due to prostate cancer or any cause after a median of 46 months.

Outcomes of brachytherapy, removal of the prostate (prostatectomy) or no definitive treatment were assessed for men less than 60 years of age at diagnosis and those aged 60 years and older.

Prostate cancer-specific mortality rates at 10 years for the younger age group were 1.3 percent with surgery, 0.5 percent with brachytherapy and 3.7 percent with no definitive therapy.

For older men, corresponding mortality rates were 3.8 percent with surgery, 5.3 percent with brachytherapy and 8.4 percent with no definitive therapy.

SOURCE: Cancer November 15, 2006.

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